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The investigation revealed the device was not returned for evaluation.No associated torque handle information was provided; the involved devices could not be acquired for review.Although no definitive root cause could be determined, review of the reported event and similar events suggests excessive force, excessive torque and/or fatigue as the likely cause or contributors.The fractured tip per surgeon¿s prerogative was left in-situ and the stainless-steel materials that were unretrieved in this event can be considered to exert very low toxicity potential and to pose negligible risk to the patient.No additional investigation can be completed.Review of the device history records of all devices notes the device released march 2021, under consignment use for over four (4) years.Additionally, no material non-conformance, no manufacturing errors, nor discrepancies with respect to material type, treatments, dimensions that may have caused or contributed to this mode of failure.Parts met acceptance criteria upon release.A labeling review was completed: "residual risks to the patient associated with use of general surgical instruments are cleaning and sterilization failures, sterile barrier compromise, corrosion, and unretrieved instrument fragments which may cause or contribute to infections, fever, wound dehiscence, immunological response and immunological, systemic, or allergic reactions.In some instances, treatment of these events may require surgical intervention including revision surgery." ".Instrument malfunctions which potentially result in surgical delays (thereby causing additional exposure to anesthesia, blood loss, and infection), a change in surgical plan, failure to achieve optimal clinical result and/or, infrequently, cancellation of a procedure.Such malfunctions include instrument fracture, which could make necessary removal difficult or sometimes impossible, with possible consequences of late infection and migration; instrument fracture may also result in injury to the patient." "residual risks to surgical staff associated with use of general surgical systems are.Instrument failures or malfunctions which prevent intended use, resulting in decreased operational efficiency and general inconvenience." "patient education: preoperative instructions to the patient are essential.The patient should be made aware of the potential risks of the surgery." "pre-operative warnings the method of use for the instruments are to be determined by the user¿s experience and training in surgical procedures." ".The instruments should be treated as any precision instrument and should be carefully placed on trays, cleaned after each use, and stored, according to generally accepted hospital methods and practices.The instruments should be carefully examined prior to use for functionality, excessive wear, or damage.A damaged instrument should not be used as this may increase the risk of malfunction and potential patient injury." ".Care should be used during surgical procedures to prevent damage to the device(s) and injury to the patient." "intra-operative warnings the physician should take precautions against putting undue stress on the spinal area with instruments.Any surgical technique should be carefully followed.It is important that the surgeon exercise extreme caution when working in close proximity to vital organs, nerves, or vessels, and that the force applied to the instrumentation is not excessive, to prevent potential injury to the patient.Over-bending, notching, striking, and/or scratching of implants with any instrument should be avoided to reduce the risk of breakage." ".The physical characteristics required for many instruments do not permit them to be manufactured from implantable materials.If any broken fragments of instruments remain in the body of a patient, they could cause allergic reactions or infections.If an instrument breaks in surgery and fragments go into the patient, these pieces should be removed prior to closure and should not be implanted." "method of use if there is any doubt or uncertainty concerning the proper use of instruments, please contact nuvasive customer service.Any available surgical techniques will be provided upon request.For optimal results, the same type of instruments used for implantation should be used for implant removal." "information to obtain a surgical technique manual or other applicable instructions for use or should any information regarding the products or their uses be required, please contact your local representative or nuvasive directly at +1-800-475-9131.You may also email: info@nuvasive.Com." 9004421-en w-2022-12 review of biocompatibility of stainless steel has provided sufficient supporting documentation for the stainless-steel type 17-4, stainless steel type 455, stainless steel type 465, and stainless-steel type 316 used in the nuvasive, inc.Medical surgical instruments at locations of potential instrument failure to be considered biocompatible.The potential long-term exposure of lodged or embedded stainless steel material in the event of instrument failure was reviewed.The aforementioned materials were determined to possess a chromium oxide passivation layer which serves to create a material with negligible potential for leachable metallic elements and virtually no potential for material-induced toxicity.Therefore, in situations where the physician has determined that removal of the instrument fragment is not possible and the only safe option is leaving it embedded in the patient, these stainless-steel materials can be considered to exert very low toxicity potential and to pose negligible risk to the patient.Risk evaluation: review of the complaint and associated risk found the effects potentially related to the reported event have been identified and mitigated and the severity of possible effects do not exceed those estimated in the risk documentation.No new harm event or adverse trend identified with the reported event.Additionally, based on the risk level estimated for this product, this complaint does not justify the need for new or additional risk evaluation.
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