inforMED
InjuryISH

OSSUR ICELOCK CLUTCH 4H 214

Received Nov 1, 2001 · Event occurred Jun 21, 2001

Report 2085446-2001-00002 · MDR key 359804

Device

Generic name

Prosthetic Liner Pin Lock Mechanism

Manufacturer

Ossur Hf

Catalog number

L-214000

Lot number

996

Product problems

  • Disconnection
  • Disengaged

Patient

59 YR

  • Bruise/Contusion
  • Fall
  • Bone Fracture(s)
  • Swelling
  • Therapy/non-surgical treatment, additional

Narrative

Description of Event or Problem

DEVICE ASSEMBLY - LOWER LIMB EXTERNAL PROSTHETIC LEG. THE PIN ATTACHMENT ON THE SOCKET LINER DISENGAGED WITH THE LOCKING MECHANISM ON THE PROSTHETIC LIMB. THE FOOT SECTION OF THE PROSTHESIS SUBSEQUENTLY BECAME DISCONNECTED FROM THE REMAINDER OF THE PROSTHESIS STILL ON THE PT'S LEG. THE PT LOST THEIR BALANCE AND FELL ON THEIR RESIDUAL LIMB RESULTING IN A FRACTURED FIBULA. WHEN THIS EVENT WAS ORIGINALLY REPORTED IN 2001, IT WAS INDICATED THAT THE PT REC'D BRUISING AND SWELLING BUT WAS OTHERWISE OK. THE CO DID PURSUE THIS EVENT VIA THE CO'S INJURY INVESTIGATION PROCEDURE, AND BASED ON DATA GATHERED CONCLUDED IT WAS NOT AN MDR EVENT. AFTER SEVERAL WEEKS THE PT BECAME DISSATISFIED WITH THEIR RECOVERY AND SOUGHT A SECOND OPINION. THE SECOND OPINION REVEALED THE FRACTURE. THE MEDICAL ADVICE WAS TO STAY OFF THE RESIDUAL LIMB AND ALLOW IT TO HEAL.

Remedial action

  • Replace
  • Patient Monitoring