K Number
K042244
Device Name
BONE-LOK MVP CORTICAL-CANCELLOUS COMPRESSION DEVICE
Date Cleared
2004-09-16

(28 days)

Product Code
Regulation Number
888.3040
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The BONE-LOK® MVP Cortical-Cancellous Compression Device is indicated for use in the general management of fractures and reconstructive surgery.
Device Description
The BONE-LOK® MVP Cortical-Cancellous Compression Device is a double-helix screw with a compression-locking collar. It is available as 3.5mm or 4.5mm diameter device with a compression looking ochan 1978 - The BONE-LOK® MVP Cortical-Cancellous Compression Device is intended for single use only. Devices provided "STERILE" are double-pouched in Tyvek®ffilm pouches and sterilized by gamma radiation.
More Information

Not Found

No
The 510(k) summary describes a mechanical orthopedic implant and does not mention any software, algorithms, or AI/ML capabilities.

Yes
The device is used in the general management of fractures and reconstructive surgery, which are therapeutic medical interventions.

No

This device is described as a "Cortical-Cancellous Compression Device" used for the "general management of fractures and reconstructive surgery," indicating it is a therapeutic or surgical implant, not a diagnostic tool.

No

The device description clearly indicates it is a physical screw with a compression-locking collar, intended for surgical implantation. This is a hardware device, not software.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is for the "general management of fractures and reconstructive surgery." This describes a surgical implant used directly on the patient's body to fix bones.
  • Device Description: The description details a "double-helix screw with a compression-locking collar," a physical device used in surgery.
  • Lack of IVD Characteristics: There is no mention of analyzing samples from the human body (like blood, urine, tissue), detecting diseases or conditions, or providing information for diagnosis.

IVD devices are used to examine specimens from the human body to provide information for diagnosis, monitoring, or screening. This device is a surgical implant used for mechanical support and fixation.

N/A

Intended Use / Indications for Use

The BONE-LOK® MVP Cortical-Cancellous Compression Device is indicated for use in the general management of fractures and reconstructive surgery.

Product codes

HWC

Device Description

The BONE-LOK® MVP Cortical-Cancellous Compression Device is a double-helix screw with a compression-locking collar. It is available as 3.5mm or 4.5mm diameter device with a compression looking ochan 1978 - The BONE-LOK® MVP Cortical-Cancellous Compression Device is intended for single use only.

Devices provided "STERILE" are double-pouched in Tyvek®ffilm pouches and sterilized by gamma radiation.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies

Performance test results indicate that the device is safe and satisfies functional performance requirements when used as indicated.

The test results demonstrate that the modified BONE-LOK® MVP Cortical-Cancellous Compression Device is substantially equivalent to the predicate device and is capable of safely and accurately performing the stated intended use.

Key Metrics

Not Found

Predicate Device(s)

K013903

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 888.3040 Smooth or threaded metallic bone fixation fastener.

(a)
Identification. A smooth or threaded metallic bone fixation fastener is a device intended to be implanted that consists of a stiff wire segment or rod made of alloys, such as cobalt-chromium-molybdenum and stainless steel, and that may be smooth on the outside, fully or partially threaded, straight or U-shaped; and may be either blunt pointed, sharp pointed, or have a formed, slotted head on the end. It may be used for fixation of bone fractures, for bone reconstructions, as a guide pin for insertion of other implants, or it may be implanted through the skin so that a pulling force (traction) may be applied to the skeletal system.(b)
Classification. Class II.

0

SEP 1 6 2004

t Notification Special 5 BONE-LOK® MVP Cortical-Cancellous Compression Device (Helical Compression Anchor System, Cannulated, Version 2)

510(k) SUMMARY OF SAFETY AND EFFECTIVENESS

SUBMITTER INFORMATION

A. Company Name:Triage Medical, Inc
B. Company Address:13700 Alton Parkway
Suite 160
Irvine, CA 92618
C. Company Phone:(949) 472-0006
D. Company Facsimile:(949) 472-0016
E. Contact Person:Gayle Hirota
Manager, Quality Assurance & Regulatory
Affairs

DEVICE IDENTIFICATION

| A. | Trade Name: | BONE-LOK® MVP Cortical-Cancellous
Compression Device |
|----|----------------------|------------------------------------------------------------------|
| B. | Catalog Number: | TMCD-35-1520S to TMCD-35-4050S
TMCD-45-3040S to TMCD-45-6070S |
| C. | Common Name: | Bone Fixation Screw |
| D. | Classification Name: | Smooth or Threaded Metallic Bone Fixation
Fastener |
| E. | Product Code: | HWC |
| F. | Device Panel: | Orthopaedic |
| G. | Device Class: | Class II (per 21 CFR 888.3040) |

IDENTIFICATION OF MODIFIED DEVICE

The BONE-LOK® MVP Cortical-Cancellous Compression Device is similar in basic design and intended use to the Triage Medical Helical Compression Anchor System, Cannulated, Version 2 cleared under 510(k) K013903. The device modification includes devices fabricated from Titanium 6Al-4V alloy, which meets the requirements of ASTM F-136.

1

DEVICE DESCRIPTION

The BONE-LOK® MVP Cortical-Cancellous Compression Device is a double-helix screw with a compression-locking collar. It is available as 3.5mm or 4.5mm diameter device with a compression looking ochan 1978 - The BONE-LOK® MVP Cortical-Cancellous Compression Device is intended for single use only.

Devices provided "STERILE" are double-pouched in Tyvek®ffilm pouches and sterilized by gamma radiation.

INTENDED USE

The BONE-LOK® MVP Cortical-Cancellous Compression Device is indicated for use in the general management of fractures and reconstructive surgery.

TECHNOLOGICAL CHARACTERISTICS

The BONE-LOK® MVP Cortical-Cancellous Compression Device is similar in basic design, construction and mechanical performance to the previously cleared Helical Compression Anchor System, Cannulated, Version 2. The device modification includes devices fabricated from titanium alloy in addition to devices fabricated from stainless steel alloy.

BIOCOMPATIBILITY AND PERFORMANCE DATA

The materials the BONE-LOK® MVP Cortical-Cancellous Compression Device are made from meet the requirements of ASTM F-138 (stainless steel) or ASTM F-136 (titanium). These materials are currently being utilized in a myriad of legally marketed orthopedic devices. Because the inertness and biocompatibility of these materials have already been established, additional testing is not required.

Performance test results indicate that the device is safe and satisfies functional performance requirements when used as indicated.

CONCLUSIONS DRAWN FROM STUDIES

The test results demonstrate that the modified BONE-LOK® MVP Cortical-Cancellous Compression Device is substantially equivalent to the predicate device and is capable of safely and accurately performing the stated intended use.

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo is a circular emblem with the department's name encircling an abstract symbol. The symbol resembles an eagle or bird in flight, composed of three curved lines. The text reads "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA".

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

SEP 1 6 2004

Ms. Gayle Hirota Manager, Quality Assurance and Regulatory Affairs Triage Medical, Inc. 13700 Alton Parkway Irvine, California 92618

Re: K042244

Trade/Device Name: BONE-LOK® MVP Cortical-Cancellous Compression Device Regulation Number: 21 CFR 888.3040 Regulation Name: Smooth or threaded metallic bone fixation fastener Regulatory Class: II Product Code: HWC Dated: August 16, 2004 Received: August 19, 2004

Dear Ms. Hirota:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food. Drug. and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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Page 2 - Ms. Gayle Hirota

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at (301) 594-4659. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Miriam C. Provost

Celia M. Witten, Ph.D., M.D. Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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SECTION 1.6 INDICATIONS FOR USE FORM

Indications for Use

510(k) Number (if known):

BONE-LOK® MVP Cortical-Cancellous Compression Device Name: Device

The BONE-LOK® MVP Cortical-Cancellous Compression Indications For Use: Device is indicated for use in the general management of fractures and reconstructive surgery.

Prescription Use X (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Miriam C. Provost

(Division Sign-Off) Division of General, Restorative, and Neurological Devices

510(k) Number K042244