inforMED
MalfunctionLYP

SACROFUSE

Received Jul 21, 2025 · Event occurred May 30, 2025

Report 3005977257-2025-00003 · MDR key 22554313

Device

Generic name

Implant Inserter

Model number

14-42003

Lot number

HB12A

Product problems

  • Material Fragmentation
  • Material Fragmentation

Patient

NA · Unknown

  • Device Embedded In Tissue or Plaque
  • Device Embedded In Tissue or Plaque

Narrative

Additional Manufacturer Narrative

DURING REVISIONS, BONY GROWTH GREATLY INCREASES THE TORQUE REQUIRED TO TURN THE SCREW. THE INSERTER TIPS CANNOT HANDLE THIS INCREASED FORCE AND, THEREFORE, BREAK OFF. THE INSERTER HAS BEEN REDESIGNED TO STRENGHTEN THE TEETH TO AVOID THIS IN THE FUTURE.

Description of Event or Problem

A SURGERY TOOK PLACE IN WHICH A SACRIX INSERTER'S TIPS BROKE OFF. THIS IS LIKELY DUE TO A DOCTOR PERFORMING A REVISION AND ATTEMPTING TO USE THE INSERTER TO REMOVE THE SCREW THAT HAS BEEN SURROUNDED BY BONY GROWTH. THIS GROWTH INCREASES THE FORCE REQUIRED TO REMOVE THE SCREW AND RESULTED IN THE BREAKING OF THE TIPS. THIS DID NOT RESULT IN PATIENT HARM AND SURGERY WAS COMPLETED. DEBRIS THAT WAS EMBEDDED IN TISSUE WAS SAFELY REMOVED.

Remedial action

  • Inspection