The Zimmer Natural Nail System Cephalomedullary Nails (ZNN™ CMN) are intramedullary nails intended for temporary internal fixation and stabilization of femoral fractures or osteotomies. Indications for the Zimmer Natural Nail System Cephalomedullary Nails (ZNN™ CMN) include:

· Compound and simple shaft fractures.
· Proximal, metaphyseal and distal shaft fractures.
· Segmental fractures.
· Comminuted fractures.
· Fractures involving osteopenic and osteoporotic bone.
· Pathological fractures.
· Fractures with bone loss
· Pseudoarthrosis, non-union, mal-union and delayed union.
· Periprosthetic fractures.
· Surgically created defects such as osteotomies.
· Intertrochanteric and subtrochanteric fractures.

The Affixus Natural Nail Humeral Nails are intramedullary nails intended for temporary internal fixation and stabilization of humeral fractures or osteotomies.

The Affixus Natural Nail Humeral Nail System is indicated for use in a variety of fractures, such as:
· Proximal fractures (proximal short and long nails only).
· Diaphyseal fractures (proximal long nails and antegrade/retrograde nails only).
· Open and closed fractures.
· Comminuted fractures.
· Nonunions and malunions.
Pathologic fractures.

Device Description

The Zimmer Natural Nail System Cephalomedullary Nails are intramedullary nails designed to restore the shape of preinjured bone and are available in a variety of lengths and diameters to meet assorted anatomical needs. Nail caps are available to protect the nail threads from tissue ingrowth and extend the nail length if necessary. Each of the intramedullary nails is secured by a series of screws that pass through holes in the nail. A set screw (with a polyethylene peg) allows guided rotational stability of the lag screw. Nails, nail caps and screws are made from Tivanium Ti-6Al-4V Alloy. Set screws are made from Tivanium Ti-6Al-4V Alloy and Polyethylene (PE). Selected components of the Zimmer Natural Nail System are color coded to aid in identifying which components should be used together. The package label for each of the nails indicates which screw sizes should be used with that nail. Each section contains the color name that matches the color/color name on the label of the appropriate screw size for that section. Refer to the color coding chart and/or surgical technique for more detailed instructions on the use of Zimmer Natural Nail System components.

The Affixus Natural Nail Humeral Nail System consists of temporary fixation intramedullary nails designed for fixation and stabilization of fractures or osteotomies of the humerus. The nails restore the shape of preinjured bone and they are available in a variety of lengths and diameters to meet assorted anatomical needs. Nail caps are available to protect the nail threads from tissue ingrowth and extend the nail length if necessary. Each of the intramedullary nails is secured by a series of screws that pass through holes in the nail.

The Ante/Retrograde Humerus Nails, Ante/Retrograde Humeral Nail Caps, Proximal Humerus Nail Caps, Washers, Cortical Bone Screws, and Blunt Tip Screws are made of Titanium alloy [Protasul®-64WF (Ti-6Al-4V) ISO 5832-3/ASTM F136] and Proximal Humerus Nails are made of Titanium alloy [Protasul-64WF (Ti-6AI-4V) ISO 5832-3/ASTM F136] and C.P Titanium [Protasul®-Ti ISO 5832-2/ASTM F67].

Package labels indicate the material of each component. Selected components of the Affixus Natural Nail Humeral Nail System instruments are color coded to aid in identifying which components should be used together. Refer to the surgical techniques for more detailed instructions on the use of Affixus Natural Nail Humeral Nail System components.

The purpose of this traditional bundled 510(k) is to update the Instructions for Use (IFU) and labels of the Zimmer® Natural Nail® System Cephalomedullary Nails and Affixus® Natural Nail® Humeral Nail System to include MR Conditional labeling. Additionally, to harmonize the content format of the IFU, some chapters of the IFUs are reorganized.

AI/ML Overview

This 510(k) summary does not contain information on acceptance criteria for a device, nor does it present a study to prove a device meets acceptance criteria related to clinical performance. Instead, this submission focuses on demonstrating substantial equivalence to predicate devices, primarily due to updates in labeling for MR Conditional compatibility and harmonization of IFU format.

Here's a breakdown of the relevant information from the provided text:

No Clinical Acceptance Criteria or Performance Data: The document explicitly states under "Clinical Performance and Conclusions:" that "Clinical data and conclusions were not needed for this device." This indicates that the submission is not based on proving clinical effectiveness against specific acceptance criteria.
Focus on Substantial Equivalence: The primary purpose of this 510(k) is to update labeling (specifically for MR Conditional use) and re-organize the Instructions for Use (IFU) for existing devices. The submission asserts substantial equivalence to legally marketed predicate devices based on identical intended use, indications for use, device description, materials, design features, lengths and diameters, and sterilization methods.

Therefore, I cannot provide the requested table of acceptance criteria and reported device performance from this document because it is not a clinical performance study.

However, I can extract the information related to the non-clinical performance testing conducted to support the MR Conditional labeling:

Table of Acceptance Criteria and Reported Device Performance (Non-Clinical):

Acceptance Criteria Description (Based on ASTM Standard)	Reported Device Performance (Implied adherence to standard)
ASTM F2503-20 (Labeling)	Devices meet labeling requirements for MR Conditional.
ASTM F2119-07R13 (Artifact)	Devices demonstrate acceptable artifact levels in MRI.
ASTM F213-17 (Torque)	Devices exhibit acceptable torque behavior in MRI.
ASTM F2052-21 (Displacement Force)	Devices show acceptable displacement forces in MRI.
ASTM F2182-19E02 (RF-heating) Preliminary Phantom Eval.	Devices have acceptable RF-heating characteristics in MRI (preliminary phantom evaluation).

Sample size used for the test set and the data provenance: Not specified in the document. Testing would typically involve representative samples of the devices.
Number of experts used to establish the ground truth for the test set and the qualifications of those experts: Not applicable. Non-clinical testing for MR compatibility is typically performed by engineers/technicians in a laboratory setting, following established ASTM protocols.
Adjudication method for the test set: Not applicable. Results are typically quantitative measurements compared against predefined limits within the ASTM standards.
If a multi reader multi case (MRMC) comparative effectiveness study was done: No. This is a non-clinical submission for MR compatibility labeling updates, not a clinical effectiveness study.
If a standalone (i.e. algorithm only without human-in-the loop performance) was done: No. This is not an AI/algorithm-based device.
The type of ground truth used: For the non-clinical MR compatibility testing, the "ground truth" is defined by the limits and methodologies specified in the referenced ASTM standards.
The sample size for the training set: Not applicable. This is not a machine learning or AI-based device.
How the ground truth for the training set was established: Not applicable.

Summary

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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and 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.

August 9, 2023

Zimmer Switzerland Manufacturing GmbH Melanie Mitrov Regulatory Affairs Sr Specialist Sulzerallee 8 Winterthur. Zürich 8404 Switzerland

Re: K231114

Trade/Device Name: Zimmer® Natural Nail® System Cephalomedullary Nails; Affixus® Natural Nail® Humeral Nail System Regulation Number: 21 CFR 888.3020 Regulation Name: Intramedullary fixation rod Regulatory Class: Class II Product Code: HSB Dated: June 12, 2023 Received: June 12, 2023

Dear Melanie Mitrov:

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.

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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 (QS) 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 medical devices and radiation-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.

Farzana
Sharmin -S
Digitally signed by Farzana
Sharmin -S
Date: 2023.08.09 14:27:40
-04'00'

Farzana Sharmin, Ph.D. Assistant Director DHT6A: Division of Joint Arthroplasty Devices OHT6: Office of Orthopedic Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known) K231114

Device Name

ZIMMER® NATURAL NAIL® SYSTEM CEPHALOMEDULLARY NAILS

Indications for Use (Describe)

· Compound and simple shaft fractures.
· Proximal, metaphyseal and distal shaft fractures.
· Segmental fractures.
· Comminuted fractures.
· Fractures involving osteopenic and osteoporotic bone.
· Pathological fractures.
· Fractures with bone loss
· Pseudoarthrosis, non-union, mal-union and delayed union.
· Periprosthetic fractures.
· Surgically created defects such as osteotomies.
· Intertrochanteric and subtrochanteric fractures.

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)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Druq Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known)

Device Name

AFFIXUS® NATURAL NAIL® HUMERAL NAIL SYSTEM

Indications for Use (Describe)

The Affixus Natural Nail Humeral Nails are intramedullary nails intended for temporary internal fixation and stabilization of humeral fractures or osteotomies.

The Affixus Natural Nail Humeral Nail System is indicated for use in a variety of fractures, such as:
· Proximal fractures (proximal short and long nails only).
· Diaphyseal fractures (proximal long nails and antegrade/retrograde nails only).
· Open and closed fractures.
· Comminuted fractures.
· Nonunions and malunions.
Pathologic fractures.

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)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

Department of Health and Human Services Food and Druq Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

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Image /page/4/Picture/1 description: The image shows the Zimmer Biomet logo. The logo consists of a blue circle with a stylized "Z" inside it, followed by the text "ZIMMER BIOMET" in a sans-serif font. The text is in a dark gray color. The logo is simple and modern.

510 (k) Summary

Sponsor:	Zimmer Switzerland Manufacturing GmbHSulzerallee 8, P.O. Box8404 Winterthur, Switzerland
Contact Person:	Melanie MitrovRegulatory Affairs Sr. SpecialistTelephone: +41 79153 08 53Fax: +41 52 244 86 58
Date:	August 7th, 2023
Trade Name:	Zimmer® Natural Nail® System Cephalomedullary Nails; Affixus®Natural Nail® Humeral Nail System.
Classification Product Code :	HSB-Rod, Fixation, Intramedullary And Accessories (21 CFR$888.3020)
Device Classification Name:	Intramedullary Fixation Rod
Regulation Number / Description:	21 CFR § 888.3020- Intramedullary Fixation Rod
Predicate Device:	Zimmer® Natural Nail™ System Cephalomedullary Nails,manufactured by Zimmer GmbH, K091566, cleared on October 28,2009
	Affixus® Natural Nail® System Humeral Nail, manufactured byZimmer GmbH, K181827, cleared on December 14, 2018
Device Description:	The Zimmer Natural Nail System Cephalomedullary Nails areintramedullary nails designed to restore the shape of preinjured boneand are available in a variety of lengths and diameters to meetassorted anatomical needs. Nail caps are available to protect the nailthreads from tissue ingrowth and extend the nail length if necessary.Each of the intramedullary nails is secured by a series of screws thatpass through holes in the nail. A set screw (with a polyethylene peg)allows guided rotational stability of the lag screw. Nails, nail caps andscrews are made from Tivanium Ti-6Al-4V Alloy. Set screws are madefrom Tivanium Ti-6Al-4V Alloy and Polyethylene (PE).Selected components of the Zimmer Natural Nail System are colorcoded to aid in identifying which components should be usedtogether. The package label for each of the nails indicates whichscrew sizes should be used with that nail. Each section contains thecolor name that matches the color/color name on the label of theappropriate screw size for that section. Refer to the color coding chartand/or surgical technique for more detailed instructions on the use ofZimmer Natural Nail System components.

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Image /page/5/Picture/1 description: The image shows the Zimmer Biomet logo. The logo consists of a blue circle with a stylized "Z" inside, followed by the text "ZIMMER BIOMET" in a simple, sans-serif font. The text is also in blue, matching the color of the circle and "Z" symbol.

. Compound and simple shaft fractures.
. Proximal, metaphyseal and distal shaft fractures.
. Segmental fractures.
. Comminuted fractures.
Fractures involving osteopenic and osteoporotic bone.
Pathological fractures.
Fractures with bone loss
Pseudoarthrosis, non-union, mal-union and delayed union. ●
Periprosthetic fractures. ●
Surgically created defects such as osteotomies. ●
Intertrochanteric and subtrochanteric fractures.

The Affixus Natural Nail Humeral Nail System nails are

Indications for use :

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BIOMET

intramedullary nails intended for temporary internal fixation and stabilization of humeral fractures or osteotomies.

The Affixus Natural Nail Humeral Nail System is indicated for use in a variety of fractures, such as:

Proximal fractures (proximal short and long nails only). ●
Diaphyseal fractures (proximal long nails and . antegrade/retrograde nails only).
Open and closed fractures.
Comminuted fractures.
. Nonunions and malunions.
. Pathologic fractures.

The subject devices have identical intended use and are substantially equivalent to the legally marketed predicated devices.

The rationale for substantial equivalence is based on consideration of the following characteristics:

Intended Use: Identical to predicates •
. Indications for Use: Identical to predicates
Device Description: Identical to the predicates .
Materials: Identical to predicates .
. Design Features: Identical to predicates
. Lengths and diameters: Identical to predicates
Sterilization: Identical to predicates

Non-Clinical Performance and Conclusions:

Evaluation of MR compatibility to support MR Conditional labeling

· ASTM F2503-20 (Labeling)
· ASTM F2119-07R13 (Artifact)
· ASTM F213-17 (Torque)
ASTM F2052-21 (Displacement Force) .
· ASTM F2182-19E02 (RF-heating) Preliminary Phantom Eval.

Clinical Performance and Conclusions:

Clinical data and conclusions were not needed for this device.

The subject devices have identical intended use and identical indications for use as the predicate devices. The subject devices use the same operating principle, incorporate the same basic design and labeling and are manufactured and sterilized using the same materials and processes as the predicate devices.

Except for the modifications to the labeling described in this submission the subject devices are identical to the predicate devices, and the performance data and analyses demonstrate that:

any differences do not raise different questions of safety and ● effectiveness as established with performance testing; and
. the subject devices are as safe and effective as the legally marketed predicate devices.

Comparison to Predicate Device:

Summary of Technological Characteristics:

Performance Data (Nonclinical and/or Clinical):

Conclusion:

Regulation Number and Section

§ 888.3020 Intramedullary fixation rod.

(a)
Identification. An intramedullary fixation rod is a device intended to be implanted that consists of a rod made of alloys such as cobalt-chromium-molybdenum and stainless steel. It is inserted into the medullary (bone marrow) canal of long bones for the fixation of fractures.(b)
Classification. Class II.