| 1 | Regulatory authorization | Confirm the device’s registration or authorization status in each intended market, including the exact device variants covered. | Requirements differ by jurisdiction. A clearance or certificate in one market does not automatically authorize sale in another. | Request current certificates, registration details, and applicable labeling. For the United States, confirm the relevant FDA pathway and device-specific status; for the EU, check applicable MDR requirements. |
| 2 | Quality management system | Check the scope, validity, and issuing body of the manufacturer’s quality-system certification, and whether it covers the relevant manufacturing site and device activities. | A certificate’s scope and site coverage matter; certification alone does not establish that a particular product is approved for your market. | Ask for an ISO 13485 certificate and audit or quality documentation appropriate to your procurement process. |
| 3 | Clinical indications and portfolio | Match the authorized indications and available nail configurations to your case mix, such as femoral, tibial, or humeral fixation and the relevant fracture patterns. | An extensive catalogue is useful only when its indications, sizes, and instruments fit local clinical practice and approved labeling. | Request product-specific instructions for use, size ranges, locking options, and indications. Have qualified clinicians assess clinical suitability. |
| 4 | Materials and traceability | Identify the implant material and verify the material specifications, production controls, and lot-level traceability for the offered device. | Material choice affects device properties and must be considered alongside the product’s validated design and intended use. | Ask for material specifications and relevant test documentation. ASTM F136 is a specification for wrought Ti-6Al-4V ELI alloy for surgical implant applications; verify whether it applies to the particular product. |
| 5 | Design verification and testing | Review evidence that the design and relevant performance characteristics have been evaluated for the intended use and product configuration. | Intramedullary fixation devices have product-specific design and performance considerations; a test result should be interpreted in its stated scope. | Ask whether ASTM F1264, a standard specification for intramedullary fixation devices, is applicable to the product and request the supporting test summary where available. |
| 6 | Instrument system and compatibility | Confirm which targeting devices, reamers, insertion tools, and locking instruments are required, supplied, and compatible with the implant system. | Complete, well-supported instrumentation helps hospitals plan operating-room workflows, training, and inventory. | Request an instrument list, compatibility matrix, cleaning instructions, and information on replacement parts and instrument-set availability. |
| 7 | Clinical and post-market evidence | Assess evidence relevant to the specific device, indications, and patient population, along with the manufacturer’s processes for complaints and safety actions. | Evidence from a different design or indication may not directly support the product being evaluated. | Request clinical evaluation or study information where available, published evidence, complaint-handling procedures, and applicable recall or field-safety-action information. |
| 8 | Sterilization and packaging | Establish whether implants are supplied sterile or non-sterile, and check validated sterilization information, packaging integrity, and shelf-life claims. | Hospitals and distributors need clear instructions for storage, handling, and any required reprocessing. | Review the label and instructions for use. Applicable sterilization standards depend on the method; examples include ISO 11135 for ethylene oxide, ISO 11137 for radiation, and ISO 17665 for moist heat. |
| 9 | Supply reliability and market support | Evaluate product availability, lead times, minimum order quantities, distribution arrangements, and continuity plans for critical sizes and instruments. | Supply constraints can affect case scheduling and inventory planning, especially when a system has many size and configuration options. | Request written service levels, forecast and replenishment procedures, local stock information, and escalation contacts for urgent orders. |
| 10 | Training, service, and total cost | Compare training and technical support, instrument maintenance, warranty terms, and the full cost of implants, sets, logistics, and servicing. | Purchase price alone does not capture the operational cost of adopting and maintaining an implant system. | Request a transparent quotation, service and warranty terms, training plan, and the expected costs of instrument replacement or maintenance. |