MAUDE Adverse Event Report: MEDOS INTERNATIONAL SÃ RL CH EXP DI POLY SCREW 10X45MM TI; ORTHOSIS, SPINAL PEDICLE FIXATION, FOR DEGENERATIVE DISC DISEASE

Model Number 179722145

Device Problem Disconnection (1171)

Patient Problem Not Applicable (3189)

Event Date 07/18/2018

Event Type  malfunction  

Manufacturer Narrative

(b)(4).Visual examination of the exp di poly screw 10 x 45 mm ti has exhibited significant signs of clinical use.The saddle cap inside the connector is rotated and the tulip head drive feature is worn, and the device exhibits severe indentation marks, consistent with the damage occurred while removing the screw.A review of the device history record was conducted.No issues were identified during the manufacturing and release of this product that could have contributed to the problem reported by the customer.All complaint trends will be evaluated as a part of the depuy spine monthly complaint review meeting.The root cause of the exp di poly screw 10 x 45 mm ti falling apart cannot be determined from the sample and the information provided.A potential root cause may be excessive force inadvertently placed on the drive feature of the screw during tightening, potentially at a significant angle, resulting in the saddle falling apart from its intended position.As there has been no issue identified in the manufacturing or release of the device that could have contributed to the problem reported by the customer and no systemic trends were found, this complaint file will be closed with no further action required.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.

Event Description

On (b)(6) 2018, the tlif surgery for lumbar spondylolisthesis was performed by using the expedium system.The fixed site was l5 ¿ s1.During the surgery, due to an excessive inserting torque, the tip of the driver (279722400) got broken and the broken tip was left in the head of the screw (either 179722145 or 179722150), which resulted in the insertion failure.The screw in question was extracted and then a new screw was inserted.No broken pieces were found left in the patient¿s body under the x-ray.The surgery was successfully completed with a 60-minute delay, and there was no adverse consequence to the patient.The surgeon has requested us to make an in-depth investigation including a possibility of metallic fatigue.

• Brand Name: EXP DI POLY SCREW 10X45MM TI
• Type of Device: ORTHOSIS, SPINAL PEDICLE FIXATION, FOR DEGENERATIVE DISC DISEASE
• Manufacturer (Section D): MEDOS INTERNATIONAL SÃ RL CH; chemin-blanc 38; le locle 02400 ; SZ 02400
• Manufacturer (Section G): MEDOS INTERNATIONAL SARL; chemin-blanc 38; le locle ; SZ
• Manufacturer Contact: jason busch ; 325 paramount drive; raynham, MA 02767 ; 5088808100
• MDR Report Key: 7847627
• MDR Text Key: 119801898
• Report Number: 1526439-2018-50846
• Device Sequence Number: 1
• Product Code: NKB
• UDI-Device Identifier: 10705034070155
• UDI-Public: (01)10705034070155
• Combination Product (y/n): N
• PMA/PMN Number: K160904
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: foreign,user facility
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 07/18/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 09/05/2018
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 179722145
• Device Catalogue Number: 179722145
• Device Lot Number: RL262493
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 08/14/2018
• Date Manufacturer Received: 08/14/2018
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 10/06/2017
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: Yes
• Type of Device Usage: Unknown
• Patient Sequence Number: 1