TREPHINE ATTACHMENT 7.0MM DIAMETER 03.111.026

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2017-07-12 for TREPHINE ATTACHMENT 7.0MM DIAMETER 03.111.026 manufactured by Synthes Bettlach.

Event Text Entries

[79840935] Patient id, date of birth and weight were not provided for reporting. Device is an instrument and is not implanted / explanted. Device history records review was completed for part# 03. 111. 026, lot# 9160075. Manufacturing location: (b)(4), manufacturing date: oct 03, 2014. No non conformance reports were generated during production. Review of the device history records showed that there were no issues during the manufacture of the product that would contribute to this complaint condition. The device was received and the product evaluation is in progress. No conclusion can be drawn. Device was used for treatment, not diagnosis. If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Patient Sequence No: 1, Text Type: N, H10


[79840936] It was report that the patient underwent original surgery on (b)(6) 2017 were the patient presented with a lisfranc injury. A right foot fusion at the first and second metatarsal was performed. Patient was implanted with one (1) compression fusion plate, 4 cortical screws in the plate, three (3) independent cortical screws that were placed directly into the midfoot bone and harvested bone graft from the patient? S medial distal tibia bone. During the procedure, while the surgeon was using the trephine attachment instrument for bone harvesting, one of the cutting tips on the graph tube attachment broke off and became embedded in the patient? S bone. Surgeon continued using the same instrument for bone harvesting. The reported fragment is approximately 2mm by 2mm square. Surgeon was aware the fragment was embedded and chose to leave it in place. Additional images were taken to identify the placement of the fragment. Also, it was reported that after the plate, and 2 of the cortical screws were implanted, the compression forceps were used. As the surgeon was using the forceps, is was reported that the spring inside the instrument had detached from the handle. No fragments were generated. Surgeon chose other forceps that was available in the operating room to complete the surgery. Surgery was completed successfully with no time delay. Patient was reported in stable condition. This report is for one (1) trephine attachment 7. 0mm diameter. This is report 1 of 1 for (b)(4).
Patient Sequence No: 1, Text Type: D, B5


[117969628] A product development investigation was performed. One trephine attachment was returned with complaint category "broken: intraoperatively". This complaint is confirmed. One of the five cutting teeth has sheared off at its base and was not returned. Whether this complaint can be replicated at customer quality (cq) is not applicable for this complaint condition as the returned device is already broken. A visual inspection under 5x magnification, device history record (dhr) review, and drawing review were performed as part of this investigation. No product design issues or discrepancies were observed. Relevant drawings were reviewed during this investigation. No product design issues or discrepancies were observed. This instrument is in the orthopedic foot instruments system used for reconstructive orthopedic foot surgery and proper use is addressed in relevant technique guide. The root cause is most likely due to excessively hard bone or excessive force. No new, unique or different patient harms were identified as a result of this evaluation. The returned part was determined to be suitable for the intended use when employed and maintained as recommended. Device was used for treatment, not diagnosis. If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number9612488-2017-10304
MDR Report Key6707613
Report SourceCOMPANY REPRESENTATIVE,HEALTH
Date Received2017-07-12
Date of Report2017-06-13
Date of Event2017-06-13
Date Mfgr Received2017-08-01
Device Manufacturer Date2014-10-03
Date Added to Maude2017-07-12
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMICHAEL COTE
Manufacturer Street1302 WRIGHTS LANE EAST
Manufacturer CityWEST CHESTER PA 19380
Manufacturer CountryUS
Manufacturer Postal19380
Manufacturer Phone6107195000
Manufacturer G1SYNTHES BETTLACH
Manufacturer StreetMURACHERSTRASSE 3
Manufacturer CityBETTLACH CH2544
Manufacturer CountrySZ
Manufacturer Postal CodeCH2544
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameTREPHINE ATTACHMENT 7.0MM DIAMETER
Generic NameTREPHINE
Product CodeHWK
Date Received2017-07-12
Returned To Mfg2017-06-23
Catalog Number03.111.026
Lot Number9160075
OperatorPHYSICIAN
Device AvailabilityR
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerSYNTHES BETTLACH
Manufacturer AddressMURACHERSTRASSE 3 BETTLACH CH2544 SZ CH2544


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 2017-07-12

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