K Number
K090975
Device Name
DEROYAL NON-LOCKING BONE FIXATION SYSTEM
Date Cleared
2010-04-12

(371 days)

Product Code
Regulation Number
888.3030
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The DeRoyal Non-Locking Bone Fixation System components are provided non-sterile. The system is intended to treat fractures of various bones, including the clavicle, scapula, iong bones, (humerus, ulna, radius, femur, tibia and fibula), small bones (metacarpals, metatarsals, and phalanges).A Screw-Plate Usage Chart is included to assist the user in selection of the appropriate screws for recommended use with each plate. Cannulated screws included in this bone fixation system are not designed to be used with specific plates. They can be used as a stand alone fracture fixation; or in the case of compromised bone stock, they can be used in conjunction with washers. The washer components are intended to prevent a screw head from breaking through the cortex of the bone by distributing the forces / load over a larger area when used for fracture fixation of large (long) bone and bone fragments. Additionally, the washers are intended to prevent the projection of the screw head when the screw must be inserted at an acute angle such as in ankle arthrodesis. The wires in this system are for use in the fixation of bone fractures, for bone reconstruction or as a guide for insertion of other medical devices.
Device Description
The DeRoyal Non-Locking Bone Fixation System components are provided non-sterile. The system includes various screws (Cortical, Cancellous, Cannulated, Shaft, Malleolar), plates (One Third Tubular, Compression, Reconstruction, T Plate, Semi-Tubular, Narrow Compression, Broad Compression), washers, and wires. A Screw-Plate Usage Chart is provided to assist in selecting appropriate screws for each plate. Cannulated screws can be used for standalone fracture fixation or with washers in compromised bone. Washers distribute force to prevent screw head breakthrough and prevent screw head projection at acute angles. Wires are for fracture fixation, bone reconstruction, or as guides for other devices.
More Information

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Not Found

No
The description details a system of mechanical components (screws, plates, washers, wires) for bone fixation and does not mention any software, algorithms, or data processing capabilities that would indicate the use of AI or ML.

No
The device is described as a non-locking bone fixation system intended for treating fractures, which falls under the category of orthopedic implants rather than therapeutic devices that actively treat or heal conditions.

No
The device is described as a "Bone Fixation System" intended to "treat fractures." Its components (screws, plates, washers, wires) are used for fixing bones or as guides for other devices, not for diagnosing conditions.

No

The device description explicitly lists physical components such as screws, plates, washers, and wires, which are hardware.

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

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens taken from the human body (like blood, urine, tissue) to provide information about a person's health. This testing is done outside of the body.
  • Device Description and Intended Use: The description clearly states that this system is used for the fixation of bone fractures and bone reconstruction. These are procedures performed within the body to physically stabilize and repair bones.
  • No Mention of Specimen Testing: There is no mention of collecting or analyzing any biological specimens.

Therefore, based on the provided information, the DeRoyal Non-Locking Bone Fixation System is a surgical implant/device used for orthopedic procedures, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The DeRoyal Non-Locking Bone Fixation System components are provided non-sterile. The system is intended to treat fractures of various bones, including the clavicle, scapula, iong bones, (humerus, ulna, radius, femur, tibia and fibula), small bones (metacarpals, metatarsals, and phalanges).A Screw-Plate Usage Chart is included to assist the user in selection of the appropriate screws for recommended use with each plate.

Cannulated screws included in this bone fixation system are not designed to be used with specific plates. They can be used as a stand alone fracture fixation; or in the case of compromised bone stock, they can be used in conjunction with washers.

The washer components are intended to prevent a screw head from breaking through the cortex of the bone by distributing the forces / load over a larger area when used for fracture fixation of large (long) bone and bone fragments. Additionally, the washers are intended to prevent the projection of the screw head when the screw must be inserted at an acute angle such as in ankle arthrodesis.

The wires in this system are for use in the fixation of bone fractures, for bone reconstruction or as a guide for insertion of other medical devices.

Product codes

HRS, HWC

Device Description

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Mentions image processing

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Mentions AI, DNN, or ML

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Input Imaging Modality

Not Found

Anatomical Site

clavicle, scapula, iong bones, (humerus, ulna, radius, femur, tibia and fibula), small bones (metacarpals, metatarsals, and phalanges)

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

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

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

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Summary of Performance Studies

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Key Metrics

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Predicate Device(s)

Not Found

Reference Device(s)

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Predetermined Change Control Plan (PCCP) - All Relevant Information

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§ 888.3030 Single/multiple component metallic bone fixation appliances and accessories.

(a)
Identification. Single/multiple component metallic bone fixation appliances and accessories are devices intended to be implanted consisting of one or more metallic components and their metallic fasteners. The devices contain a plate, a nail/plate combination, or a blade/plate combination that are made of alloys, such as cobalt-chromium-molybdenum, stainless steel, and titanium, that are intended to be held in position with fasteners, such as screws and nails, or bolts, nuts, and washers. These devices are used for fixation of fractures of the proximal or distal end of long bones, such as intracapsular, intertrochanteric, intercervical, supracondylar, or condylar fractures of the femur; for fusion of a joint; or for surgical procedures that involve cutting a bone. The devices may be implanted or attached through the skin so that a pulling force (traction) may be applied to the skeletal system.(b)
Classification. Class II.

0

Image /page/0/Picture/1 description: The image shows the seal of the Department of Health & Human Services (HHS) of the United States. The seal features a circular design with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" arranged around the perimeter. Inside the circle is a stylized image of an eagle with its wings spread, symbolizing the department's mission to protect the health of all Americans.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room W-O66-0609 Silver Spring, MD 20993-0002

APR 1 2 2010

DeRoval Industries, Inc. % Ms. Gracie Greenway Sr. Regulatory Affairs Specialist 200 DeBusk Lane Powell, Tennessee 37849

Re: K090975

Trade/Device Name: DeRoyal Non-Locking Bone Fixation System Regulation Number: 21 CFR 888.3030 Regulation Name: Single/multiple component metallic bone fixation appliances and accessories Regulatory Class: Class II Product Code: HRS, HWC Dated: March 18, 2010 Received: March 19, 2010

Dear Ms. Greenway:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you; however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to 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

1

Page 2 - Ms. Gracie Greenway

CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Karbare Buehup

Mark N. Melkers Director Division of Surgical, Orthopedic and Restorative Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

K 090975

p. 1/2

Indications for Use

510(k) Number: K090975

Device Name: DeRoyal Non-Locking Bone Fixation System

Indications for Use: The DeRoyal Non-Locking Bone Fixation System components are provided non-sterile. The system is intended to treat fractures of various bones, including the clavicle, scapula, iong bones, (humerus, ulna, radius, femur, tibia and fibula), small bones (metacarpals, metatarsals, and phalanges).A Screw-Plate Usage Chart is included to assist the user in selection of the appropriate screws for recommended use with each plate.

Cannulated screws included in this bone fixation system are not designed to be used with specific plates. They can be used as a stand alone fracture fixation; or in the case of compromised bone stock, they can be used in conjunction with washers.

The washer components are intended to prevent a screw head from breaking through the cortex of the bone by distributing the forces / load over a larger area when used for fracture fixation of large (long) bone and bone fragments. Additionally, the washers are intended to prevent the projection of the screw head when the screw must be inserted at an acute angle such as in ankle arthrodesis.

The wires in this system are for use in the fixation of bone fractures, for bone reconstruction or as a guide for insertion of other medical devices.

Prescription Use × (Part 21 CFR 801 Subpart D)

AND/OR Over-The-Counter Use (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Smittn for mxn
(Division Sign-Off)

Page 1 of 2

Division of Surgical, Orthopedic, and Restorative Devices

510(k) Number K090975

3

Cannulated screws are not designed to be used with specific plates. hastead as a stand alone fracture fixat
Or, in the case of compromised bone stock, they can be used in co

| Drawing

NumberDescription2.7mm Cortical Screw4.0mm Cancellous Screw6.5mm Cancellous Screw3.5mm Cortical Screw4.5mm Cortical Screw4.5mm Malleolar Screw4.0mm Cannulated Screw4.5mm Cannulated Screw3.5mm Shaft Screw4.5mm Shaft Screw4.6ID3.3ID3.6ID6.6ID
227102.7mm Cortical ScrewXXXXXXX
14010.14.0mm Cancellous ScrewXXXXXXX
16530.56.5mm Cancellous ScrewXXXXX
235103.5mm Cortical ScrewXXXXXXX
245144.5mm Cortical ScrewXXXXX
345254.5mm Malleolar ScrewXXXX
54010.34.0mm Cannulated ScrewX
54520.24.5mm Cannulated ScrewX
635163.5mm Shaft ScrewXXXXX
645284.5mm Shaft ScrewXXXXX
Drawing
NumberDescriptionOne Third Tubular Plate3.5mm Compression Plate3.5mm Reconstruction Plate3.5mm T Plate 4 Head HoleSemi-Tubular Plate4.5mm T Plate4.5mm Narrow Compression Plate4.5mm Broad Compression PlateWasher33101336523370423313
73561One Third Tubular Plate
73564.53.5mm Compression PlateX
735583.5mm Reconstruction PlateX
8355643.5mm T Plate 4 Head HoleX
74571Semi-Tubular PlateX
745844.5mm T PlateX
745701.54.5mm Narrow Compression PlateX
7451062.54.5mm Broad Compression PlateX
33101WasherX
33101X
33652X
337042X
3313X

Screw - Plate Usage Chart

:

2 2

09075