FDA Adverse Event Malfunction Summary report: N

Y-KNOT ALL-SUTURE ANCHOR DRILL BIT

MDR report key: 3030807 · Received April 2, 2013

Report

Report Number
1017294-2013-00012
Event Type
Malfunction
Date Received
April 2, 2013
Date of Event
February 28, 2013
Report Date
March 5, 2013
Manufacturer
CONMED LINVATEC
Product Code
GFG
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
PA, US
Reporter Occupation
NURSE

Narratives

Additional Manufacturer Narrative · 1

CONMED LINVATEC RECEIVED A BROKEN DRILL BIT FOR EVALUATION. VISUAL INSPECTION OF THE RETURNED DRILL BIT CONFIRMED THE REPORTED BREAKAGE AND THE BROKEN PORTION WAS NOT RETURNED. A REVIEW OF THE DEVICE HISTORY RECORDS SHOWED LOT #397314 WAS MANUFACTURED ON SEPTEMBER 10, 2012 IN A LOT OF (B)(4) UNITS WITH NO NOTED DISCREPANCIES DURING THE MANUFACTURING PROCESS THAT COULD HAVE CAUSED OR CONTRIBUTED TO THE REPORTED BREAKAGE. THERE WERE NO OTHER SIMILAR COMPLAINTS RECEIVED FOR THIS ITEM AND LOT NUMBER COMBINATION. THIS IS A RELATIVELY NEW DEVICE WHICH IS VERY TECHNIQUE DEPENDENT. EVALUATION OF SIMILAR COMPLAINTS REVEALED THAT THE MOST LIKELY CAUSE OF THIS SUSPECTED FAILURE IS USER-RELATED. THIS FAILURE MODE IS ADDRESSED IN THE DFMEA, AND THE SAFETY RISK HAS BEEN FOUND TO BE ACCEPTABLE. TO REDUCE THE RISK OF DRILL BIT BREAKAGE AND INJURY TO THE PATIENT, THE INSTRUCTION FOR USE (IFU) PROVIDED THE FOLLOWING WARNINGS AND PRECAUTIONS: PRIOR TO USE, REMOVE ALL PROTECTIVE PACKAGING AND TIP PROTECTOR, IF APPLICABLE. INSPECT INSTRUMENTS PRIOR TO USE TO ENSURE THEY ARE IN GOOD PHYSICAL CONDITION. THERE SHOULD BE NO LOOSE, BROKEN OR MISALIGNED PARTS. INSPECT INSTRUMENTS AFTER USE TO ENSURE THEY HAVE NOT BEEN DAMAGED. DO NOT USE EXCESSIVE FORCE ON INSTRUMENTS TO AVOID DAMAGE OR BREAKAGE DURING USE. DO NOT USE INSTRUMENTS TO PRY, AS BENDING OR BREAKAGE MAY OCCUR. EXERCISE CARE WHEN USING THE DRILL BIT AND DRILL GUIDE. APPLYING SIDE OR BENDING LOADS MAY CAUSE DRILL BIT BREAKAGE, OVERSIZED TUNNEL OR GENERATION OF METAL PARTICULATES. DO NOT RE-SHARPEN, RE-STERILIZE, OR REUSE. SOME INSTRUMENTS MAY BE EXTREMELY SHARP. HANDLE WITH CARE TO AVOID INJURY. THE DRILL BIT IS SINGLE USE AND MUST BE DISPOSED ACCORDING TO HOSPITAL POLICY AND PROCEDURES.

Additional Manufacturer Narrative · 1

TO DATE THE DEVICE HAS NOT BEEN RETURNED FOR EVALUATION. A FOLLOW UP REPORT WILL BE FILED UPON RECEIPT OF THE DEVICE AND COMPLETION OF THE EVALUATION.

Description of Event or Problem · 1

IT WAS REPORTED THAT DURING USE OF THIS Y-KNOT ALL-SUTURE ANCHOR DRILL BIT IN A LEFT ANKLE ARTHROSCOPIC PROCEDURE, THE TIP BROKE OFF. THE TIP WAS REMOVED, THE SURGERY WENT ON AND COMPLETED AS INTENDED WITHOUT ANY FURTHER COMPLICATION. X-RAY WAS ALSO PERFORMED TO VERIFY THAT THE TIP WAS REMOVED. OTHER THAN A SHORT DELAY OF A FEW MINUTES TO REMOVE THE TIP, THERE WAS NO SERIOUS INJURY TO THE PATIENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
134503 Y-KNOT ALL-SUTURE ANCHOR DRILL BIT BIT, SURGICAL GFG CONMED LINVATEC 397314

Patients

Seq Age Sex Outcome Treatment
1