FDA Adverse Event Injury Summary report: N

3.5MM LCP HOOK PLATE 3 HOLE

MDR report key: 5011839 · Received August 18, 2015

Report

Report Number
1000562954-2015-10166
Event Type
Injury
Date Received
August 18, 2015
Report Date
June 24, 2015
Manufacturer
SYNTHES MEZZOVICO
Product Code
HRS
PMA / PMN Number
PK082072
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
CA, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

PATIENT INFORMATION IS NOT AVAILABLE FOR REPORTING. DATE OF EVENT: UNKNOWN. DATE OF IMPLANT IS UNKNOWN, BUT REPORTEDLY OCCURRED ABOUT ONE AND ONE HALF YEARS PRIOR TO (B)(6) 2015 (B)(4) IS USED TO REPORT THE REVISION SURGERY THAT TOOK PLACE, ALTHOUGH THERE IS NO ALLEGATION AGAINST THE DEVICE. DEVICE HISTORY REVIEW: MANUFACTURING LOCATION: (B)(4) - MANUFACTURING DATE: JUNE 26, 2012. NO NON-CONFORMANCE REPORTS WERE GENERATED DURING PRODUCTION. REVIEW OF THE DEVICE HISTORY RECORD(S) SHOWED THAT THERE WERE NO ISSUES DURING THE MANUFACTURE OF THE PRODUCT THAT WOULD CONTRIBUTE TO THIS COMPLAINT CONDITION. PRODUCT INVESTIGATION SUMMARY: THE COMPLAINT CONDITION FOR THE 2.7MM/3.5MM VA-LCP EXTENDED MEDIAL DISTAL HUMERUS PLATE (PART 02.117.601 / LOT 7828110) AND THE 3.5MM LCP HOOK PLATE (PART 02.113.103 / LOT 7960007) WAS LIKELY CAUSED BY IMPROPER PLATE PLACEMENT, IMPLANT MIGRATION, OR UNUSUAL PATIENT ANATOMY. HOWEVER, THIS COMPLAINT IS NOT LIKELY A RESULT OF ANY DESIGN RELATED DEFICIENCY. NO PRODUCT ISSUE WAS IDENTIFIED UPON EXAMINATION OF THE THREE RETURNED UNKNOWN SCREWS. THE 2.7MM/3.5MM VA-LCP EXTENDED MEDIAL DISTAL HUMERUS PLATE AND THE 3.5MM LCP HOOK PLATE ARE IMPLANTS ROUTINELY USED IN THE 2.7MM/3.5MM VARIABLE ANGLE LCP ELBOW SYSTEM. THE TWO (2) PLATES WERE RETURNED AND REPORTED TO HAVE BEEN PROMINENT POSTOPERATIVELY. THIS CONDITION IS UNCONFIRMED; HOWEVER, IT IS LIKELY SINCE THE PATIENT REQUESTED THAT THE HARDWARE BE REMOVED. IT IS LIKELY THAT IMPROPER PLATE PLACEMENT, IMPLANT MIGRATION, OR UNUSUAL PATIENT ANATOMY LED TO THE COMPLAINT CONDITION. BOTH PLATES ARE IN CONDITION CONSISTENT WITH INSERTION AND REMOVAL. BOTH PLATES ALSO SHOW DISCOLORATION. THE ASSOCIATED DRAWINGS WERE REVIEWED AND DETERMINED TO BE SUITABLE FOR THE INTENDED DESIGN, APPLICATION, AND DIMENSIONAL CONFORMITY WHEN USED AS RECOMMENDED. DEVICE 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.

Description of Event or Problem · 1

IT WAS REPORTED THAT ON AN UNKNOWN DATE, THE PATIENT UNDERWENT THE IMPLANTATION OF AN UNKNOWN PLATE AND AN UNKNOWN QUANTITY OF UNKNOWN SCREWS TO TREAT A LATERAL HUMERUS FRACTURE. APPROXIMATELY ONE AND A HALF YEARS LATER, ON (B)(6) 2015, THE PATIENT UNDERWENT A PLANNED HARDWARE REMOVAL DUE TO PROMINENT APPEARANCE OF THE HARDWARE. DURING THE PLATE REMOVAL, THE HEADS OF AN UNKNOWN QUANTITY OF 3.5MM CORTICAL SCREWS, POPPED OFF (BROKE OFF) WHILE THE SURGEON WAS REMOVING THE PLATE. THE SHAFTS OF THE SCREWS ARE RETAINED IN THE PATIENT'S BONE. THE PROCEDURE WAS SUCCESSFULLY COMPLETED WITH NO FURTHER PATIENT HARM TO THE PATIENT. THIS COMPLAINT ADDRESSES THE NEED FOR REVISION SURGERY DUE TO PROMINENCE. THE INTRAOPERATIVE SCREW BREAKAGE WAS ADDRESSED AND REPORTED UNDER A SEPARATE, RELATED COMPLAINT ((B)(4)). UPDATE: IT WAS REPORTED THAT A 3.5 MM LOCKING COMPRESSION (LCP) 3-HOLE HOOK PLATE WAS INCLUDED WITH THE HARDWARE REMOVED ON (B)(6) 2015 (DUE TO PROMINENCE) AS WELL AS THREE (3) INTACT SCREWS AND FIVE (5) BROKEN SCREW HEADS. IT WAS UNKNOWN IF THE PLATE WAS ASSOCIATED WITH ANY OF THE BROKEN SCREWS. THE BROKEN SCREWS WILL BE REPORTED AND INVESTIGATED WITH AN ASSOCIATED RECORD ((B)(4)). THIS REPORT IS 3 OF 3 FOR (B)(4).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
545817 3.5MM LCP HOOK PLATE 3 HOLE PLATE, FIXATION, BONE HRS SYNTHES MEZZOVICO 7960007

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention