UNIVERSAL DRIVER SHAFT
Report
- Report Number
- 0002249697-2014-02036
- Event Type
- Malfunction
- Date Received
- June 3, 2014
- Date of Event
- May 13, 2014
- Report Date
- May 13, 2014
- Manufacturer
- STRYKER ORTHOPAEDICS-MAHWAH
- Product Code
- LXH
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- JA
- Reporter Occupation
- OTHER
Narratives
WHEN COMPLETED, THE INVESTIGATION RESULTS WILL BE SUBMITTED IN A SUPPLEMENTAL REPORT.
AN EVENT REGARDING A FRACTURED HEXALOBULAR SCREWDRIVER TIP FROM A TRIDENT DRIVER WAS REPORTED. THE EVENT WAS CONFIRMED. METHOD AND RESULTS: DEVICE EVALUATION AND RESULTS: THE DEVICE WAS RETURNED IN USED CONDITION. THE TIP OF THE HEXALOBULAR FEATURE IS FRACTURED; DEFORMATION TO THE REMAINING PORTION INDICATES THE FRACTURE OCCURRED WHILE TIGHTENING A SCREW, CONSISTENT WITH THE EVENT DESCRIPTION. MEDICAL RECORDS RECEIVED AND EVALUATION: A REVIEW OF MEDICAL RECORDS WAS NOT PERFORMED AS NONE WERE PROVIDED. NO FURTHER INFORMATION WAS REQUESTED AS THERE IS NO INDICATION THE FAILURE WAS RELATED TO PATIENT FACTORS. DEVICE HISTORY REVIEW INDICATED THE DEVICES ACCEPTED INTO FINAL STOCK FROM THE REPORTED LOT WERE FREE FROM DISCREPANCIES. COMPLAINT HISTORY REVIEW FOUND THERE HAVE BEEN OTHER EVENTS FOR THE MANUFACTURING LOT. PREVIOUS INVESTIGATIONS HAVE FOUND THE ROOT CAUSE TO BE RELATED TO EXCESSIVE TORQUE APPLIED TO THE DEVICE BY THE USER. CONCLUSIONS: THE ROOT CAUSE WAS DETERMINED TO BE APPLICATION OF EXCESSIVE FORCE BY THE USER.
DURING A THA, WHEN A SURGEON SCREWING A SCREW, THE TIP OF DRIVER BROKE. HE ATTEMPTED TO REMOVE THE FRAGMENT FROM THE SCREW HEAD BUT HE COULD NOT REMOVE IT. BECAUSE, IT GOT STUCK INTO THE HEAD. THEREFORE, HE IMPLANTED INSERT AS IS.
DURING A THA, WHEN A SURGEON SCREWING A SCREW, THE TIP OF DRIVER BROKE. HE ATTEMPTED TO REMOVE THE FRAGMENT FROM THE SCREW HEAD BUT HE COULD NOT REMOVE IT. BECAUSE, IT GOT STUCK INTO THE HEAD. THEREFORE, HE IMPLANTED INSERT AS IS.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 325204 | UNIVERSAL DRIVER SHAFT | INSTRUMENT | LXH | STRYKER ORTHOPAEDICS-MAHWAH | F5A9383 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Other |