K Number

Device Name

DVR® Crosslock Wrist Spanning Plate (131849181)

Manufacturer

Pioneer Surgical Technology, Inc D.B.A Resolve Surgical Tech

Date Cleared

2022-04-28

(90 days)

Product Code

HRS

Regulation Number

888.3030

Intended Use

The DVR® Crosslock Wrist Spanning Plate is indicated for skeletally mature patients for fixation of fractures, osteotomies and non-unions of the distal radius.

Device Description

The DVR® Crosslock Wrist Spanning Plate is a single-use plate for the fixation of fractures, osteotomies and non-unions of the distal radius. The plate spans the patient's wrist and is placed from the radial shaft to the second or third metacture pattern and patient anatomy. The plate provides ligamentotaxis on a temporary basis while the distal radius heals. The DVR® Crosslock Wrist Spanning Plate consists of a single, sterile-packed plate and is manufactured from titanium alloy (Ti-6AL-4V). The plate features hole clusters consisting of locking screw holes, a central screw cluster, and K-wire holes for preliminary fixation. There is a dorsal bend at the distal end of the plate to accommodate patient anatomy.

More Information

Contact

Type

Center

Panel

Date Received

Product Code

Subsequent Product Codes

Applicant Name (Manufacturer)

Device Name

Decision

Street 1

Street 2

City

State

Country Code

ZIP

Postal Code

Class Advise Committee

SSP Indicator

Third Party Reviewed

Expedited Review

Predicate Devices

K143749, K000734, K211408, K111528

Reference Devices

Not Found

AI/ML (Artificial Intelligence / Machine Learning)

No
The device description and performance studies focus on the mechanical properties and safety of a bone plate, with no mention of AI or ML.

Therapeutic

Yes
The device is indicated for fixation of fractures, osteotomies, and non-unions of the distal radius, providing temporary support while healing, which aligns with the definition of a therapeutic device.

Diagnostic

The device is a plate intended for fixation of fractures, osteotomies, and non-unions of the distal radius, which is a therapeutic rather than diagnostic function.

SaMD (Software as a Medical Device)

The device description explicitly states it is a "single-use plate" manufactured from "titanium alloy" and describes its physical features and intended surgical use, indicating it is a physical implant, not software.

IVD (In Vitro Diagnostic)

Based on the provided information, the DVR® Crosslock Wrist Spanning Plate is not an IVD (In Vitro Diagnostic) device.

Here's why:

IVD devices are used to examine specimens derived from the human body (like blood, urine, tissue) to provide information about a person's health. The description of the DVR® Crosslock Wrist Spanning Plate clearly states it is a surgical implant used for the fixation of fractures, osteotomies, and non-unions of the distal radius. It is a physical device implanted in the body, not used to test samples outside the body.
The intended use and device description focus on mechanical support and stabilization of bone. This is characteristic of orthopedic implants, not diagnostic tests.
There is no mention of analyzing biological samples or providing diagnostic information. The device's function is purely structural.

Therefore, the DVR® Crosslock Wrist Spanning Plate falls under the category of a surgical implant or orthopedic device, not an In Vitro Diagnostic device.

PCCP (Predetermined Change Control Plan) Authorized

N/A

Overview

Intended Use / Indications for Use

The DVR® Crosslock Wrist Spanning Plate is indicated for skeletally mature patients for fixation of fractures, osteotomies and non-unions of the distal radius.

Product codes

HRS

Device Description

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

distal radius, radial shaft, second or third metacture

Indicated Patient Age Range

skeletally mature patients

Intended User / Care Setting

Prescription Use

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

Nonclinical tests were submitted and relied on in the premarket notification for a determination of substantial equivalence. ASTM F382-17 (Standard Specification and Test Method for Metallic Bone Plates) testing has passed acceptance criteria established by the predicate device, where applicable. The supporting evidence in this subject device is substantially equivalent to the predicate devices.
Static testing of the subject device (bending structural stiffiess and bending strength) passed the primary predicate acceptance criteria. Fatigue testing of the subject device (fatigue runout) met the primary predicate acceptance criterial that the subject device is as safe, as effective, and performs as well as the primary predicate. In addition, MR Safety analysis and testing supports MR Conditional labeling.

Key Metrics

Not Found

Predicate Device(s)

K143749, K000734, K211408, K111528

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

Regulation Number and Section

§ 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.

Summary

April 28, 2022

Image /page/0/Picture/1 description: The image shows the logo of the U.S. Food & Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

Pioneer Surgical Technology, Inc D.B.A Resolve Surgical Tech Jaclyn Holli Sr. Specialist, Regulatory Affairs 375 River Park Circle Marquette, Michigan 49855

Re: K220244

Trade/Device Name: DVR® Crosslock Wrist Spanning Plate Regulation Number: 21 CFR 888.3030 Regulation Name: Single/Multiple Component Metallic Bone Fixation Appliances And Accessories Regulatory Class: Class II Product Code: HRS Dated: January 27, 2022 Received: January 28, 2022

Dear Jaclyn Holli:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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 of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

Shumaya Ali, M.P.H. Assistant Director DHT6C: Division of Restorative, Repair and Trauma Devices OHT6: Office of Orthopedic Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

Indications for Use

510(k) Number (if known) K220244

Device Name DVR® Crosslock Wrist Spanning Plate

Indications for Use (Describe)

The DVR® Crosslock Wrist Spanning Plate is indicated for skeletally mature patients for fixation of fractures, osteotomies and non-unions of the distal radius.

X Prescription Use (Part 21 CFR 801 Subpart D)

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

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			510(k) Summary		Prepared on: 2022-04-28
Contact Details					21 CFR 807.92(a)(1)
Applicant Name			Pioneer Surgical Technology, Inc D.B.A Resolve Surgical Technologies
	Applicant Address		375 River Park Circle Marquette MI 49855 United States
	Applicant Contact Telephone		9062269909
	Applicant Contact		Ms. Jaclyn Holli
	Applicant Contact Email			jholli@resolvesurg.com
Device Name					21 CFR 807.92(a)(2)
	Device Trade Name			DVR® Crosslock Wrist Spanning Plate
	Common Name			Single/multiple component metallic bone fixation appliances and accessor
	Classification Name			Plate, Fixation, Bone
	Regulation Number			888.3030
	Product Code			HRS
Legally Marketed Predicate Devices					21 CFR 807.92(a)(3)
	Predicate #		Predicate Trade Name (Primary Predicate is listed first)		Product Code
	K143749		Arthrex Distal Radius System		HRS
	K000734		Extended GTR Device		KTT
	K211408		CervAlign® Anterior Cervical Plate System		KWQ
	K111528	PIONEER ASPECT ANTERIOR CERVICAL PLATE MODEL 24			KWQ

Device Description Summary

Intended Use/Indications for Use

The DVR® Crosslock Wrist Spanning Plate is indicated for skeletally mature patients for fixation of fractures and non-unions of the distal radius.

21 CFR 807.92(a)(5)

21 CFR 807.92(a)(4)

Indications for Use Comparison

21 CFR 807.92(a)(5)

The subject device is only indicated for use in the the predicate device includes additional anatomical locations. The subject indications also identify the target population, as recommended for medical device labeling. The subject indications and inclusion of patient population do not affect safety and effectiveness of the device when used as labeled.

Technological Comparison

21 CFR 807.92(a)(6)

The subject system has the same or similar fundamental technology (indication regulation, principles of operation, geometric shape, materials, sterility, surgical, and MR compatibility) as the primary predicate. The subject system has the same or similar fundamental technology (shelf-life, packaging, biological safety, and sterilization parameters) as the reference predicates. Nonclinical tests were submitted and relied on in the premarket notification for a determination of substantial equivalence. ASTM F382-17 (Standard Specification and Test Method for Metallic Bone Plates) testing has passed acceptance criteria established by the predicate device, where applicable. The supporting evidence in this subject device is substantially equivalent to the predicate devices.

Non-Clinical and/or Clinical Tests Summary & Conclusions 21 CFR 807.92(b)

ASTM F382-17 Standard Specification and Test Method for Metallic Bone Plates testing was conducted in the determination of substantial equivalence. A 4-point bend test was performed via static and fatigue testing (bending strength, and fatigue runout) to determine substantial equivalence of the primary predicate. In addition, MR Safety analysis and testing was conducted per ASTM F2213, F2052, and F2182 to support MR Conditional labeling.

Clinical Data - Not Applicable

Static testing of the subject device (bending structural stiffiess and bending strength) passed the primary predicate acceptance criteria. Fatigue testing of the subject device (fatigue runout) met the primary predicate acceptance criterial that the subject device is as safe, as effective, and performs as well as the primary predicate. In addition, MR Safety analysis and testing supports MR Conditional labeling.