MediPoint: Trauma Fixation – Global Analysis and Market Forecasts

Publisher Name :
Date: 31-Oct-2013
No. of pages: 231

Traumatic injury patients that come into the Emergency Room (ER) experience orthopedic injury in the form of fractures 60% to 65% of the time, based on GlobalData’s conversations with key opinion leaders. Of this population, 45%-50% are operable and require fracture repair techniques in the form of external or internal fixation. As the global population continues to grow in the emerging markets, with overcrowding and economic growth, some of the drivers for trauma fixation include motor vehicle accidents and aging.

The trauma fixation market can generally be segmented into the two buckets of high-energy fractures from the young patient under age 45, or the elderly population above age 65 that experiences low-energy fractures. For the aging, osteoarthritis has become a global public health concern with no cure. This is an indication that is growing rapidly, afflicting all joints. As hip fixation continues to be up to 20% of the trauma market, this segment is expected to continue to grow. The extremities segment also continues to drive growth, which consists of approximately another 20% of the market. Sporting injuries, vehicular accidents, violence and falls are the primary factors that make this trauma fixation market grow at a rate of 6.8%, far higher than that of the joint replacement markets within the hip and knee space. Generally, fixation devices such as plates, screws, intramedullary nails and external fixation are far cheaper than joint replacement, and are thus a preferred treatment methodology when clinically feasible.

This report focuses on the trauma fixation market, which includes internal and external fixation devices. The orthopedic trauma market has been estimated in this report, which covers the US, France, Germany, Italy, Spain, the UK, Japan, Brazil, China and India. The report provides unmet needs, future adoption and compound annual growth rates (CAGR). GlobalData’s analysis shows that while the orthopedics implant market is mature, where products have become commodities, trauma fixation is one that has room for more technological development and adoption. With the market in the APAC regions being highly fragmented with local players, there will be a continued battle for market share by the top five leaders through technological innovation and investment in establishing strong distribution networks. The major opportunity lies within the emerging markets such as India and China, which have a large patient population, and the key for growth will be realigning with the local distribution network and acquisitions of local market players.


Key Questions Answered

  • The trauma fixation market is expected to continue its growth through the forecast period with growth driven by high energy and low energy fractures. (Q).What are the primary patient segments and different product offerings in trauma?
  • Trauma fixation technology took a sharp turn in the early 2000s with the quick adoption of locking screw technology, polyaxial screwing, and intramedullary nail improvements. (Q).Will technology drive the market? How have the indications changed and are procedural numbers growing proportionately to market size?
  • Joint replacement in orthopedics is growing rapidly in the extremities. And the extremities market is a growth driver for trauma fixation as well. (Q).Do we see replacement implants growth eating into the trauma market share? What are the future trends and are the emerging markets?
  • There are Asian manufacturers entering the US market looking to grab market share in the US and EU. And the market is increasingly fragmented in trauma fixation. (Q).Which product segment will have the most innovation? Who are the large players in trauma in each product segment?

Reasons to buy

“What Physicians Think” quotes provide a unique insight into how healthcare professionals are reacting to events within the industry, and what their responses could mean for industry strategists. In this report you will understand the perceptions of leading Orthopedic Trauma Surgeons from around the world. This information is essential for all strategic decision makers in every organization allowing them to act on high quality information.

MediPoint: Trauma Fixation – Global Analysis and Market Forecasts

Table of Contents

1 Table of Contents 8
1.1 List of Tables 14
1.2 List of Figures 19

2 Introduction 21
2.1 Catalyst 22
2.2 Related Reports 23
2.3 Upcoming Related Reports 23

3 Disease Overview 24
3.1 Anatomy and Physiology 24
3.1.1 Bone Biology 24
3.1.2 Skeletal Structure 24
3.2 Pathophysiology 27
3.2.1 Overview 27
3.2.2 Post-Traumatic Arthritis 27
3.2.3 Fracture 27
3.3 Clinical Presentation 28
3.3.1 Symptoms 28
3.3.2 Fracture Types 29
3.3.3 Fractures by Location 31
3.3.4 Hip Injury 33
3.4 Clinical Outcomes 34
3.4.1 Immobilization 34
3.4.2 Plates and Screws 35
3.4.3 Intramedullary Nails 37
3.4.4 Hip Fixation Device Options 37
3.4.5 External Fixation 40

4 Industry Overview 41
4.1 Overview 41
4.2 Procedure Trends 43
4.2.1 US 43
4.2.2 EU 44
4.2.3 APAC 45
4.2.4 South America 46
4.3 Market Access 47
4.3.1 US 47
4.3.2 EU 53
4.3.3 APAC 60
4.3.4 South America 67
4.4 Regulatory Issues / Recalls 70
4.4.1 Rigid FX FDA Warning Letter 70
4.4.2 DePuy Orthopedics LBS Lower Extremity Dovetail Intercalary Component Recall 70
4.5 Mergers, Acquisitions and Partnerships 71
4.5.1 Zimmer Acquires NORMED Medizin-Technik 71
4.5.2 Smith & Nephew Acquires Adler Mediequip Private Limited 71
4.5.3 Smith & Nephew plc Announces Acquisition of Brazil Distribution Business 71
4.5.4 Biomet Inc. Acquires DePuy Trauma 71
4.5.5 Zimmer Acquires ExtraOrtho XtraFix External Fixation Product Line 72
4.5.6 DePuy Orthopaedics (Johnson & Johnson) and Synthes Inc. Merge 72
4.5.7 Synthes Inc. and AO Foundation Partnership 72
4.6 Economic Impact 73
4.6.1 Developed Countries 73
4.6.2 Emerging Markets 74
4.7 Market Drivers 74
4.7.1 Rising Prevalence 74
4.7.2 Development Due to War 77
4.7.3 Bone Regeneration 78
4.7.4 Commoditization of Orthopedic Market 79
4.7.5 Patient Demand and Awareness 79
4.7.6 Technological Developments 80
4.7.7 Rising Competition and Innovation through Small Players 81
4.7.8 Materials Development 82
4.8 Market Opportunities 83
4.8.1 Mergers and Acquisitions 83
4.8.2 Emerging Markets 84
4.8.3 Extremities Growth 84
4.8.4 Capitalizing on Market Fragmentation 86
4.9 Market Barriers 87
4.9.1 Burden of Rising Regulation 87
4.9.2 Proving Efficacy 88
4.9.3 Pricing Pressures and Reimbursement 89
4.9.4 Medical Device Excise Tax 90
4.10 Substitutes 90
4.10.1 Joint Replacement 90
4.10.2 Generic Implants 91
4.10.3 External Fixation 92

5 Competitive Assessment 93
5.1 Overview 93
5.2 Global Market Share 93
5.2.1 Global Market Share 93
5.2.2 US Market Share 96
5.2.3 EU Market Share 100
5.3 Marketed Products 102
5.3.1 Key Internal Fixation Products 104
5.3.2 Key External Fixation Devices 135

6 Unmet Needs 139
6.1 Addressing the Complications 139
6.2 Advanced Materials Research 139
6.3 Improving Borderline Patient Treatment Outcomes 140
6.4 Bioabsorbable Technology Development 141
6.5 Centralization 141
6.6 Cost Containment 142
6.7 Drug-Eluting Implants 143
6.8 Long-Term Clinical Data 143
6.9 Trauma Registry 145

7 Pipeline Products 147
7.1 Overview 147
7.2 Product Profiles 147
7.2.1 Drug-Releasing Screws by Bioretec 147
7.2.2 Small Bone Innovations Arthrodesis Plates 147
7.2.3 Semprus Biosciences Trauma Fixation Devices 147
7.2.4 Nanova Inc. Bioabsorbable Bone Screws 147
7.2.5 CAMBfix Ltd. Pipeline 148
7.2.6 Nutek Orthopaedics LLC External Fixation Pipeline 148
7.2.7 Innovia LLC Develops IM Nail 148

8 Clinical Trials to Watch 149
8.1 Overview 149
8.2 Orthopedic Trauma Patient Quality of Life Trial 149
8.3 Non-Operative vs. Operative Management of Olecranon Fractures 150
8.4 Smith & Nephew INTUIT Hip Fracture Study 150
8.5 Distal Radius Fracture Fixation Comparison 151
8.6 Nails versus Plates for Femur Fractures in Dar es Salaam, Tanzania 151

9 Current and Future Players 152
9.1 Trends in Corporate Strategy 152
9.2 Company Profiles 153
9.2.1 Acumed 153
9.2.2 Biomet 155
9.2.3 DePuy Synthes International 157
9.2.4 Integra LifeSciences 159
9.2.5 Orthofix 161
9.2.6 OsteoMed 163
9.2.7 Small Bone Innovations, Inc. 164
9.2.8 Smith & Nephew 166
9.2.9 Stryker 168
9.2.10 Tornier 170
9.2.11 Trimed Inc. 172
9.2.12 Wright Medical 174
9.2.13 Zimmer 176
9.2.14 Companies in Trauma 179

10 Market Outlook 183
10.1 Major Markets Overview 183
10.2 US 186
10.3 EU 188
10.3.1 Overview 188
10.3.2 France 190
10.3.3 Germany 192
10.3.4 Italy 194
10.3.5 Spain 195
10.3.6 UK 197
10.4 APAC 199
10.4.1 Overview 199
10.4.2 Japan 199
10.4.3 China 200
10.4.4 India 202
10.5 South America 204
10.5.1 Brazil 204

11 Appendix 208
11.1 Abbreviations 208
11.2 Bibliography 210
11.3 Research Methodology 221
11.3.1 Overview 221
11.3.2 Coverage 221
11.3.3 Secondary Research 222
11.3.4 Forecasting Methodology 222
11.3.5 Primary Research - Key Opinion Leader Interviews 224
11.3.6 Primary Research - Physician Survey 224
11.3.7 Expert Panel Validation 226
11.4 Physicians and Specialists Included in this Study 226
11.4.1 Dr. Philippe Bellemère 226
11.4.2 Julio Duarte Clemente, MD, PhD. 226
11.4.3 Dr. Moussa Hamadouche 226
11.4.4 Dr. Vidhya Ravi 226
11.4.5 Robert M. Szabo, MD, MPH 227
11.4.6 Dr. Marcello Zaia Oliveira 227
11.4.7 Robert Zura, MD 227
11.5 About the Authors 228
11.5.1 Analysts 228
11.5.2 Global Head of Healthcare 229
11.6 About MediPoint 230
11.7 About GlobalData 230
11.8 Disclaimer 230

List of Tables

Table 1: Clinical Symptoms and Descriptions 28
Table 2: Fracture Locations in the Body 32
Table 3: Locking Plates vs. Non-Locking Plates Features 35
Table 4: IM Nail Technical Specifications 37
Table 5: Fixation Types for Hip Fractures 38
Table 6: Medicare Coding Guide for Trauma Fixation, 2013 52
Table 7: Medicare National Payment Average for Trauma in the Hand, 2013 52
Table 8: Regulatory Differences Between the US and EU 53
Table 9: Direct and Indirect Costs of Orthopedics 73
Table 10: Acumed Lower Extremity Internal Fixation Products and Screws 104
Table 11: Acumed Upper Extremity Internal Fixation Products 105
Table 12: Acumed Plate and Screw Systems SWOT 106
Table 13: Acumed IM Nail Systems SWOT 106
Table 14: Biomet Internal Fixation Plates and Screws 107
Table 15: Biomet Internal Fixation IM Nails 108
Table 16: Biomet Plate and Screw Systems SWOT 108
Table 17: Biomet IM Nail Systems SWOT 109
Table 18: Bioretec Internal Fixation Implants 110
Table 19: Bioretec Bioabsorbable Screws SWOT 110
Table 20: DePuy Synthes Plates and Screws 111
Table 21: DePuy Synthes Intramedullary Nails 112
Table 22: DePuy Synthes Plate and Screw Systems SWOT 113
Table 23: DePuy Synthes IM Nail Systems SWOT 113
Table 24: Extremity Medical Plates, Screws and Nails 114
Table 25: Extremity Medical Internal Fixation Systems SWOT 114
Table 26: Integra Life Sciences Lower Extremity Internal Fixation Products 115
Table 27: Integra Life Sciences Upper Extremity Internal Fixation Products 116
Table 28: Integra Life Sciences Internal Fixation Systems SWOT 117
Table 29: Orthofix Internal Fixation Plates and Screws 118
Table 30: Orthofix Internal Fixation IM Nails 118
Table 31: Orthofix Plate and Screw Systems SWOT 118
Table 32: Orthofix IM Nails SWOT 119
Table 33: Osteomed Internal Fixation Lower Extremity 119
Table 34: Osteomed Internal Fixation Upper Extremity 120
Table 35: Osteomed Upper Extremity Systems SWOT 120
Table 36: Osteomed Lower Extremity Systems SWOT 120
Table 37: Small Bone Innovations Internal Fixation Lower Extremity 121
Table 38: Small Bone Innovations Internal Fixation Upper Extremity 121
Table 39: SBi Upper Extremity Systems SWOT 122
Table 40: SBi Lower Extremity Systems SWOT 122
Table 41: Smith & Nephew Internal Fixation 123
Table 42: Smith & Nephew Plate and Screw Systems SWOT 124
Table 43: Stryker Internal Fixation Upper Extremity 124
Table 44: Stryker Internal Fixation Lower Extremity 125
Table 45: Stryker Internal Fixation Foot and Ankle 126
Table 46: Stryker Upper Extremity Systems SWOT 127
Table 47: Stryker Lower Extremity Systems SWOT 127
Table 48: Tornier Internal Fixation Upper Extremity 128
Table 49: Tornier Plate and Screw Systems SWOT 129
Table 50: Trimed Internal Fixation Lower Extremity 129
Table 51: Trimed Internal Fixation Upper Extremity 130
Table 52: Trimed Plate and Screw Systems SWOT 130
Table 53: Wright Medical Internal Fixation Lower Extremity Plates and Screws 131
Table 54: Wright Medical Internal Fixation Upper Extremity Plates and Screws 132
Table 55: Wright Medical Lower Extremity Plate and Screw Systems SWOT 133
Table 56: Wright Medical Upper Extremity Plate and Screw Systems SWOT 133
Table 57: Zimmer Internal Fixation Plates and Screws 134
Table 58: Zimmer Internal Fixation IM Nails 134
Table 59: Zimmer Plate and Screw Systems SWOT 134
Table 60: Zimmer IM Nail System SWOT 135
Table 61: Biomet External Fixation 135
Table 62: DePuy Synthes External Fixation 135
Table 63: Orthofix External Fixation 136
Table 64: Smith & Nephew External Fixation 137
Table 65: Stryker External Fixation 137
Table 66: Wright Medical External Fixation 138
Table 67: Zimmer External Fixation 138
Table 68: Orthopedic Trauma Patient Quality of Life Trial 149
Table 69: Non-Operative vs. Operative Management of Olecranon Fractures 150
Table 70: INTUIT Hip Fracture Outcome Study 150
Table 71: Distal Radius Fracture Fixation Comparison 151
Table 72: Nails versus Plates for Femur Fractures in Dar es Salaam, Tanzania 151
Table 73: Company Profile - Acumed LLC 153
Table 74: SWOT Analysis - Acumed LLC 154
Table 75: Company Profile - Biomet Orthopedics 155
Table 76: SWOT Analysis - Biomet Orthopedics 156
Table 77: Company Profile - DePuy Synthes International 158
Table 78: SWOT Analysis - DePuy Synthes International 159
Table 79: Company Profile - Integra LifeSciences Inc. 160
Table 80: SWOT Analysis - Integra LifeSciences Inc. 161
Table 81: Company Profile - Orthofix Inc. 162
Table 82: SWOT Analysis - Orthofix Inc. 162
Table 83: Company Profile - OsteoMed 163
Table 84: SWOT Analysis - OsteoMed 164
Table 85: Company Profile - Small Bone Innovations Inc. 165
Table 86: SWOT Analysis - Small Bone Innovations Inc. 165
Table 87: Company Profile - Smith & Nephew 166
Table 88: SWOT Analysis - Smith & Nephew 167
Table 89: Company Profile - Stryker 169
Table 90: SWOT Analysis - Stryker 170
Table 91: Company Profile - Tornier N.V. 171
Table 92: SWOT Analysis - Tornier N.V. 172
Table 93: Company Profile - Trimed, Inc. 173
Table 94: SWOT Analysis - Trimed 173
Table 95: Company Profile - Wright Medical 174
Table 96: SWOT Analysis - Wright Medical 175
Table 97: Company Profile - Zimmer Holdings Inc. 177
Table 98: SWOT Analysis - Zimmer Holdings, Inc. 178
Table 99: Trauma Companies in the Global Market 179
Table 100: Trauma Companies in APAC Market 181
Table 101: Trauma Fixation Sales ($m) Forecast for the Major Markets, 2010-2019 184
Table 102: Trauma Fixation Sales ($m) Forecast for the US, 2010-2019 187
Table 103: Trauma Fixation Sales ($m) Forecast for the EU, 2010-2019 189
Table 104: Trauma Fixation Sales ($m) Forecast for France, 2010-2019 191
Table 105: Trauma Fixation Sales ($m) Forecast for Germany, 2010-2019 193
Table 106: Trauma Fixation Sales ($m) Forecast for Italy, 2010-2019 194
Table 107: Trauma Fixation Sales ($m) Forecast for Spain, 2010-2019 196
Table 108: Trauma Fixation Sales ($m) Forecast for the UK, 2010-2019 197
Table 109: Trauma Fixation Sales ($m) Forecast for Japan, 2010-2019 199
Table 110: Trauma Fixation Sales ($m) Forecast for China, 2010-2019 201
Table 111: Trauma Fixation Sales ($m) Forecast for India, 2010-2019 203
Table 112: Trauma Fixation Sales ($m) Forecast for Brazil, 2010-2019 207

List of Figures

Figure 1: Skeletal Structure 25
Figure 2: Joint Structure 26
Figure 3: Fracture Types 29
Figure 4: Hip Fracture Types 33
Figure 5: Hip Fracture Distribution 38
Figure 6: Fracture by Bones, 2008 41
Figure 7: Global Product Sales Volume for Trauma Fixation, 2010-2019 42
Figure 8: US Product Sales Volume for Trauma Fixation, 2010-2019 43
Figure 9: EU Product Sales Volume for Trauma Fixation, 2010-2019 44
Figure 10: APAC Product Sales Volume for Trauma Fixation, 2010-2019 45
Figure 11: South America Product Sales Volume for Trauma Fixation, 2010-2019 46
Figure 12: US Adoption of Nails vs. Plate Systems vs. External Fixation, 2010-2015 50
Figure 13: US Adoption of Locking vs. Non-Locking Plates, 2010-2015 51
Figure 14: EU Adoption of Locking vs. Non-Locking Plates, 2010-2015 55
Figure 15: EU Adoption of Nails vs. Plate Systems vs. External Fixation, 2010-2015 55
Figure 16: Sources of Orthopedic Trauma (%) 75
Figure 17: Global Market Share for Plates and Screw Systems, 2012 94
Figure 18: Global Market Share for IM Nails, 2012 95
Figure 19: Global IM Nails Breakdown, 2012 95
Figure 20: Global Market Share for External Fixation, 2012 96
Figure 21: US Market Share for Trauma Fixation, 2012 97
Figure 22: US Market Share for Plates and Screw Systems, 2012 98
Figure 23: US Market Share for IM Nails, 2012 99
Figure 24: US Market Share for External Fixation, 2012 100
Figure 25: EU Market Share for Plates and Screw Systems, 2012 101
Figure 26: EU Market Share for IM Nails, 2012 101
Figure 27: EU Market Share for External Fixation Systems, 2012 102
Figure 28: Influencing Factors for Plate and Screw Products 103
Figure 29: Challenging Aspects in Trauma Surgery 144
Figure 30: Trauma Fixation Revenue by Major Market, 2012 and 2019 185
Figure 31: US Sales ($m) Forecast for Trauma Fixation, 2010-2019 187
Figure 32: EU Sales ($m) Forecast for Trauma Fixation, 2010-2019 189
Figure 33: France Sales ($m) Forecast for Trauma Fixation, 2010-2019 191
Figure 34: Germany Sales ($m) Forecast for Trauma Fixation, 2010-2019 193
Figure 35: Italy Sales ($m) Forecast for Trauma Fixation, 2010-2019 195
Figure 36: Spain Sales ($m) Forecast for Trauma Fixation, 2010-2019 196
Figure 37: UK Sales ($m) Forecast for Trauma Fixation, 2010-2019 198
Figure 38: Japan Sales ($m) Forecast for Trauma Fixation, 2010-2019 200
Figure 39: China Sales ($m) Forecast for Trauma Fixation, 2010-2019 202
Figure 40: India Sales ($m) Forecast for Trauma Fixation, 2010-2019 204
Figure 41: Brazil Sales ($m) Forecast for Trauma Fixation, 2010-2019 207
Figure 42: Surgeon Location Breakdown Trauma Survey (n=103) 225
Figure 43: Surgeon Practice Setting Trauma Survey (n=103) 225

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