MAUDE Adverse Event Report: SMITH & NEPHEW, INC. LGN TIBIAL DRILL GUIDE SIZE 8; PLATE, FIXATION, BONE

Catalog Number	71434341
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	02/14/2019
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that the device broke during surgery.The procedure was not delayed.It is unknown whether there was a back-up device and how was the surgery completed.It is unknown if there was an impact to the patient.
Additional Manufacturer Narrative
The associated device was returned and evaluated.A visual inspection of the returned device confirmed the stated failure mode.The device fractured into two pieces at the handle / plate connection point and both pieces were returned.The device was manufactured in 2006 and exhibits signs of extensive wear/ usage.A review of complaint history did not reveal additional complaints for the listed batch.At this time, we have no reason to suspect that the product failed to meet any product specifications at the time of manufacture.We recommend that all reusable instruments be routinely inspected for wear and damage and replaced as necessary.Based on this investigation, the need for corrective action is not indicated.Should additional information be received, the complaint will be reopened.No further investigation is warranted for this complaint; however we will continue to monitor for future complaints and investigate as necessary.We consider this investigation closed.
Event or Problem Description
It was reported that during surgery the device broke while using on the patient's incision.All broken pieces were recovered, the procedure was completed with no delays using an s&n backup device, and there was no injury or affectation to the patient.The final outcome was good.

• Brand Name: LGN TIBIAL DRILL GUIDE SIZE 8
• Common Device Name: PLATE, FIXATION, BONE
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks road; memphis TN 38116
• MDR Report Key: 8400387
• Report Number: 1020279-2019-00976
• Device Sequence Number: 18930014
• Product Code: HRS
• UDI-Device Identifier: 03596010549914
• UDI-Public: 03596010549914
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K123055
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 04/16/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Catalogue Number: 71434341
• Device Lot Number: 06FM17086
• Initial Date Received by Manufacturer: 02/14/2019
• Supplement Date Received by Manufacturer: 02/14/2019
• Initial Report FDA Received Date: 03/07/2019
• Supplement Report FDA Received Date: 04/16/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1