GRAFT DELIVERY SYSTEM MODEL SA-6115

K100754 · Micromedics, Inc. · FMF · Jun 9, 2010 · General Hospital

Device Facts

• Record ID: K100754
• Device Name: GRAFT DELIVERY SYSTEM MODEL SA-6115
• Applicant: Micromedics, Inc.
• Product Code: FMF · General Hospital
• Decision Date: Jun 9, 2010
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 880.5860
• Device Class: Class 2

Intended Use

FibriJet® Graft Delivery System is intended for the delivery of hydrated allograft, autograft or synthetic bone graft material to an orthopedic surgical site. In addition, it is designed to facilitate the premixing of bone graft materials with fluids such as I.V. fluids, blood, plasma concentrate, platelet rich plasma, bone marrow or other specified blood components deemed necessary by the clinical use requirements.

Device Story

FibriJet® Graft Delivery System is a manual orthopedic surgical tool used to mix and deliver bone graft materials. Components include a syringe barrel, end cap, plunger, funnel, dual liquid applicator, blending connector, and cups/lids. The device is operated by a surgeon or clinical staff in an orthopedic surgical setting. It functions by allowing the user to premix bone graft materials with various fluids (e.g., blood, plasma, bone marrow) and then manually dispense the hydrated mixture into the surgical site. The device simplifies the preparation and application of graft materials, potentially improving surgical efficiency and graft handling during orthopedic procedures.

Clinical Evidence

No clinical data provided; bench testing only.

Technological Characteristics

Manual piston syringe system. Components include syringe barrel, end cap, plunger, funnel, dual liquid applicator, blending connector, and cups/lids. Non-powered, manual operation. Materials and configuration are consistent with predicate devices.

Indications for Use

Indicated for patients requiring delivery of hydrated allograft, autograft, or synthetic bone graft material to an orthopedic surgical site. Facilitates premixing of graft materials with fluids (e.g., blood, plasma, bone marrow).

Regulatory Classification

Identification

A piston syringe is a device intended for medical purposes that consists of a calibrated hollow barrel and a movable plunger. At one end of the barrel there is a male connector (nozzle) for fitting the female connector (hub) of a hypodermic single lumen needle. The device is used to inject fluids into, or withdraw fluids from, the body.

Predicate Devices

• Curved Delivery Option & Graft Preparation System (K072330)
• Harvest Graft Delivery System (K043261)

Submission Summary (Full Text)

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K100754

JUN - 9 2010

## 510(k) SUMMARY

## FIBRIJET® GRAFT DELIVERY SYSTEM

| <b>SUBMITTED BY:</b> | |
|----------------------|--|
|----------------------|--|

Micromedics, Inc. 1270 Eagan Industrial Road St.Paul, MN 55121-1385

CONTACT PERSON:

TELEPHONE: FAX:

Tom Lopac, Manager of Quality & Regulatory Affairs [e-mail] 651-452-1977 651-452-1787

DATE PREPARED:

March 15, 2010

TRADE NAME:

FibriJet® Graft Delivery System

COMMON NAME: PRO CODE:

Piston Syringe FMF

### SUBSTANTIALLY EQUIVALENT PREDICATE DEVICES:

Curved Delivery Option & Graft Preparation System (Biomet Biologics, Warsaw, IN) K072330 Harvest Graft Delivery System (Harvest Technologies Corp., Plymouth, MA) K043261

#### DEVICE DESCRIPTION:

The FibriJet® Graft Delivery System consists of the Graft Delivery Device, a dual liquid applicator, a blending connector and cups and lids. The Graft Delivery Device itself consists of a syringe barrel, end cap, plunger and funnel.

#### INDICATIONS FOR USE:

FibriJet® Graft Delivery System is intended for the delivery of hydrated allograft or synthetic bone graft material to an orthopedic surgical site. In addition, it is designed to facilitate the premixing of bone graft materials with fluids such as I.V. fluids, blood, plasma concentrate, platelet rich plasma, bone marrow or other specified blood components deemed necessary by the clinical use requirements.

#### TECHNOLOGICAL CHARACTERISTICS:

The FibriJet® Graft Delivery System has the same technological characteristics and is similar in overall design, materials and configuration compared to the predicate devices.

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Image /page/1/Picture/1 description: The image is a black and white logo for the Department of Health & Human Services USA. The logo consists of a circular border with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" written around it. Inside the circle is a stylized image of an eagle or bird-like figure with three curved lines representing its wings or body.

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

JUN - 9 2010

Micromedics, Inc. % Mr. Tom Lopac Quality Manager 1270 Eagan Industrial Road Saint Paul, Minnesota 55121-1385

Re: K100754

Trade/Device Name: FibriJet® Graft Delivery Syringe Regulation Number: 21 CFR 880.5860 Regulation Name: Piston syringe Regulatory Class: II Product Code: FMF Dated: June 2, 2010 Received: June 3, 2010

Dear Mr. Lopac:

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. Iisting 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 device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set

.

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Page 2 - Mr. Tom Lopac

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/ReportalProblem/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 [phone] or [phone] or at its Internet address http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours,

urs,

elkerson

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

Enclosure

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# STATEMENT OF INDICATIONS FOR USE

510(k) Number (if known):

Device Name: FibriJet® Graft Delivery Syringe

Indications for Use:

FibriJet® Graft Delivery System is intended for the delivery of hydrated allograft, autograft or synthetic bone graft material to an orthopedic surgical site. In addition, it is designed to facilitate the premixing of bone graft materials with fluids such as I.V. fluids, blood, plasma concentrate, platelet rich plasma, bone marrow or other specified blood components deemed necessary by the clinical use requirements.

Prescription Use: X (Per 21 CFT 801.109)

Over-The-Counter

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

OR

Concurrence of CDRH, Office of Device Evaluation (ODE)

Neil R. Ogden for mxm.

(Division Sign-C Division of Surgical, Orthopedic, and Restorative Devices

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