K Number
K162353
Date Cleared
2017-04-13

(233 days)

Product Code
Regulation Number
888.3040
Reference & Predicate Devices
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The MICA™ Screw is indicated for fixation of bone fractures or for bone reconstruction. Examples include:

  • · Mono or Bi-Cortical osteotomies in the foot or hand
  • · Distal or Proximal metatarsal or metacarpal osteotomies
  • · Weil osteotomy
  • · Fusion of the first metatarsophalangeal joint and interphalangeal joint
  • · Fixation of osteotomies for Hallux Valgus treatment (such as Scarf, Chevron, etc.)
  • · Akin type osteotomy
  • · Arthrodesis base first metatarsal cuneiform joint to reposition and stabilize metatarsus varus primus
  • Calcaneus/cuboid arthrodesis
  • · Talar/navicular arthrodesis
Device Description

The MICA™ Screws are intended for use in bone reconstruction, osteotomy, arthrodesis, fracture repair, and fracture fixation of bones appropriate for the size of the device. All MICA™ Screws are fully threaded, cannulated screws made from titanium alloy.

AI/ML Overview

The provided document describes the MICA™ Screw System, a medical device for bone fixation, and its substantial equivalence to a predicate device, rather than an AI/ML powered device. Therefore, many of the requested details about acceptance criteria for AI performance and study design for AI models (e.g., sample size for test/training sets, expert ground truth, MRMC studies, standalone performance) are not applicable to this document.

However, I can extract the acceptance criteria and performance data for the non-clinical testing performed on the MICA™ Screw System.

1. Table of acceptance criteria and the reported device performance

Validation and/or Verification MethodAcceptance Value/CriteriaReported Device Performance
Torsional Testing: Insertion Torque, Removal Torque, Ultimate TorqueUltimate Torque must exceed insertion torque and removal torque by a safety factorAcceptable
Engineering Analysis: Axial Pullout Force, Bending StrengthComparable to the predicate device designAcceptable
Bacterial Endotoxins Testing≤20 EU/deviceAcceptable

2. Sample size used for the test set and the data provenance (e.g., country of origin of the data, retrospective or prospective)

This information is not provided in the document. The testing described is non-clinical, involving mechanical and material properties of the device, not patient data.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

This information is not applicable as the testing is non-clinical and does not involve human experts establishing ground truth for diagnostic or prognostic purposes.

4. Adjudication method for the test set

This information is not applicable as the testing is non-clinical.

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

This is not applicable as the document describes a mechanical bone screw system, not an AI/ML powered device.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

This is not applicable as the document describes a mechanical bone screw system, not an AI/ML powered device.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)

For the non-clinical tests, the "ground truth" or reference standards are engineering specifications, established mechanical test methods, and predefined thresholds for material properties (e.g., specific torque values, force limits, endotoxin levels).

8. The sample size for the training set

This is not applicable as the document describes a mechanical bone screw system, not an AI/ML powered device.

9. How the ground truth for the training set was established

This is not applicable as the document describes a mechanical bone screw system, not an AI/ML powered device.

{0}------------------------------------------------

Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized image of three human profiles facing right, layered on top of each other to create a sense of depth. The profiles are connected to a symbol that resembles a bird's wing or a flowing ribbon. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES-USA" is arranged in a circular pattern around the image.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

Wright Medical Technology, Inc. Tara Conrad Regulatory Affairs Specialist II 1023 Cherry Rd Memphis. Tennessee 38117

April 13, 2017

Re: K162353

Trade/Device Name: MICA 10 Screw System Regulation Number: 21 CFR 888.3040 Regulation Name: Smooth Or Threaded Metallic Bone Fixation Fastener Regulatory Class: Class II Product Code: HWC Dated: March 13, 2017 Received: March 17, 2017

Dear Ms. Conrad:

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 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical devicerelated 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.

{1}------------------------------------------------

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education 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. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 Industry and Consumer Education 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,

Mark N. Melkerson -S

Mark N. Melkerson Director Division of Orthopedic Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

{2}------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known)

K162353

Device Name MICA™ Screw System

Indications for Use (Describe)

The MICA™ Screw is indicated for fixation of bone fractures or for bone reconstruction. Examples include:

  • · Mono or Bi-Cortical osteotomies in the foot or hand
  • · Distal or Proximal metatarsal or metacarpal osteotomies
  • · Weil osteotomy
  • · Fusion of the first metatarsophalangeal joint and interphalangeal joint
  • · Fixation of osteotomies for Hallux Valgus treatment (such as Scarf, Chevron, etc.)
  • · Akin type osteotomy
  • · Arthrodesis base first metatarsal cuneiform joint to reposition and stabilize metatarsus varus primus
  • Calcaneus/cuboid arthrodesis
  • · Talar/navicular arthrodesis
Type of Use (Select one or both, as applicable)
---------------------------------------------------

X Prescription Use (Part 21 CFR 801 Subpart D)

__ Over-The-Counter Use (21 CFR 801 Subpart C)

PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON A SEPARATE PAGE IF NEEDED.

FOR FDA USE ONLY

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

Form Approved: OMB No. 0910-0120 Expiration Date: January 31, 2017 See PRA Statement on last page.

{3}------------------------------------------------

K162353 Page 1 of 2

Headquarters Wright Medical Technology, Inc.

1023 Cherry Road Memphis, TN 38117

018679971 mt.com

Image /page/3/Picture/4 description: The image shows the logo for Wright, a company that focuses on excellence. The logo features two overlapping trapezoids, one red and one orange, to the left of the word "WRIGHT" in red, block letters. Below the word "WRIGHT" is the phrase "FOCUSED EXCELLENCE" in a smaller, sans-serif font.

510(K) SUMMARY OF SAFETY AND EFFECTIVENESS

In accordance with the Food and Drug Administration Rule to implement provisions of the Safe Medical Devices Act of 1990 and in conformance with 21 CFR 807.92, this information serves as a Summary of Safety and Effectiveness for the use of the MICA™ Screw System.

1. Submitted By:Wright Medical Technology, Inc.1023 Cherry RoadMemphis, TN 38117
Date:April 12, 2017
K Number:K162353
Contact Person:Tara ConradRegulatory Affairs Specialist IIOffice (901) 867-4367Fax (901) 867-4190
2. Proprietary Name:MICA TM Screw System
Common Name:Cannulated Bone Screw
Classification Name and Reference:21 CFR 888.3040- Class II- Smooth or threadedmetallic bone fixation fastener
Device Product Code, Device Panel:HWC - Orthopedic
3. Predicate Device:K082320- Wright TM Compression Screw

4. Device Description

The MICA™ Screws are intended for use in bone reconstruction, osteotomy, arthrodesis, fracture repair, and fracture fixation of bones appropriate for the size of the device. All MICA™ Screws are fully threaded, cannulated screws made from titanium alloy.

5. Intended Use and Indications for Use

The MICA™ Screw is indicated for fixation of bone fractures or for bone reconstruction. Examples include:

  • · Mono or Bi-Cortical osteotomies in the foot or hand
  • · Distal or Proximal metatarsal or metacarpal osteotomies
  • · Weil osteotomy
  • · Fusion of the first metatarsophalangeal joint and interphalangeal joint

{4}------------------------------------------------

  • · Fixation of osteotomies for Hallux Valgus treatment (such as Scarf, Chevron, etc.)
  • · Akin type osteotomy
  • Arthrodesis base first metatarsal cuneiform joint to reposition and stabilize metatarsus varus primus
  • Calcaneus/cuboid arthrodesis
  • Talar/navicular arthrodesis

6. Technological Characteristics Comparison

The MICA Screw System has similar indications, utilizes similar instrumentation, is made from identical materials, and has identical sterilization methods when compared to the legally marketed predicate devices

7. Substantial Equivalence- Non-Clinical Evidence

Validation and/orVerification MethodAcceptance Value/CriteriaResults
Torsional Testing- Insertion Torque- Removal Torque- Ultimate TorqueUltimate Torque must exceedinsertion torque and removaltorque by a safety factorAcceptable
Engineering Analysis- Axial Pullout Force- Bending StrengthComparable to the predicatedevice designAcceptable
Bacterial Endotoxins Testing≤20EU/deviceAcceptable

8. Substantial Equivalence- Clinical Evidence

N/A

9. Substantial Equivalence- Conclusions

The design characteristics of the subject devices do not raise any different types of questions of safety or effectiveness. From the evidence submitted in this 510(k), the subject devices can be expected to perform at least as well as the predicate systems and are substantially equivalent.

§ 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.