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U.S. Market for Orthopedic Trauma Devices 2012 Published on June 2012

Report Summary With the increasing mean age of the population of the U.S., the market for orthopedic trauma bone fixation devices is experiencing strong growth. Many fracture types increase in prevalence in accordance with age. Fracture rates increase because of the overall fragility of bone as it ages along with a higher incidence rate of osteoporosis in elderly patients. This report includes analysis of the following fixation devices: - Orthopedic plates and screws - Bioabsorbable fixation - Intramedullary nails - Large, medium and small cannulated screws - Intramedullary hip screws - Conventional hip screws - External fixators - Long bone stimulators - Additional trauma devices Within the orthopedic trauma device market, companies such Biomet, DePuy, Smith & Nephew, Stryker and Synthes lead the market. This report provides a comprehensive and detailed analysis of market revenues by device type, market forecasts through 2016, unit sales, average selling prices, market drivers and limiters and a detailed competitive analysis, including manufacturer market shares and product portfolios.

Table of Content

TABLE OF CONTENTS EXECUTIVE SUMMARY. 1 1.1 U.S. ORTHOPEDIC TRAUMA DEVICES MARKET ... 1 1.2 ORTHOPEDIC TRAUMA PROCEDURES ..... 2 1.3 GROWTH TRENDS BY SEGMENT ...... 3 1.4 PLATE AND SCREW MARKET.... 4 1.5 BIOABSORBABLE FIXATION MARKET..... 5 1.6 INTRAMEDULLARY NAIL MARKET .. 6 1.7 CANNULATED SCREW MARKET 7 1.8 INTRAMEDULLARY HIP SCREW MARKET ...... 8 1.9 CONVENTIONAL HIP SCREW MARKET.... 9

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>> Get this Report Now by email! 1.10 STAPLE FIXATION MARKET.. 10 1.11 BONE PIN MARKET . 11 1.12 EXTERNAL FIXATION MARKET.... 12 1.13 LONG BONE STIMULATOR MARKET... 13 1.14 COMPETITIVE ANALYSIS ...... 14 RESEARCH METHODOLOGY... 15 2.1 RESEARCH SCOPE ..... 15 2.2 IDATA'S 9-STEP METHODOLOGY .. 15 Step 1: Project Initiation & Team Selection ... 16 Step 2: Prepare Data Systems and Perform Secondary Research..... 18 Step 3: Preparation for Interviews & Questionnaire Design ..... 19 Step 4: Performing Primary Research..... 20 Step 5: Research Analysis: Establishing Baseline Estimates ..... 22 Step 6: Market Forecast and Analysis ..... 23 Step 7: Identify Strategic Opportunities .. 25 Step 8: Final Review and Market Release ...... 26 Step 9: Customer Feedback and Market Monitoring.... 27 U.S. ORTHOPEDIC TRAUMA DEVICE MARKET .... 28 3.1 INTRODUCTION .. 28 3.1.1 Anatomy and Pathology.... 28 3.1.1.1 Anatomy .....28 3.1.1.2 Pathology and Healing ...29 3.1.2 Treatment Overview... 29 3.1.2.1 Internal Fixation......29 3.1.2.2 External Fixation .....29 3.1.2.3 Bone Growth Stimulation ......29 3.2MARKET OVERVIEW. 30 3.2.1 Internal Fixation . 30 3.2.1.1 Plates and Screws ....30 3.2.1.2 Bioabsorbable Fixation ..30 3.2.1.3 Intramedullary Nails30 3.2.1.4 Cannulated Screws ..30 3.2.1.5 Intramedullary Hip Screws....30 3.2.1.6 Conventional Hip Screws ......30 3.2.1.7 Staple Fixation..30 3.2.1.8 Bone Pins...30 3.2.2 External Fixation 30 3.2.3 Long bone stimulator . 30 3.3 TREND ANALYSIS BY SEGMENT.... 35 3.4MARKET DRIVERS AND LIMITERS . 38 3.4.1 Market Drivers.... 38 3.4.2 Market Limiters... 38 3.5 COMPETITIVE ANALYSIS . 39 3.5.1 Market Concentration 44 3.6MERGERS AND ACQUISITIONS 45 PROCEDURE NUMBERS...... 48 4.1 OVERVIEW .. 48 4.1.1 Procedural Definitions ..... 48

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>> Get this Report Now by email! 4.1.2 Total Procedures. 48 4.1.3 Procedural Analysis by Region 48 4.1.3.1 Upper Extremities....48 4.1.3.2 Hip ......49 4.1.3.3 Lower Extremities....49 PLATE AND SCREW MARKET.. 52 5.1 INTRODUCTION .. 52 5.1.1 General Product Description... 52 5.1.2 Locking Plates..... 52 5.1.3 Hybrid Plates ...... 52 5.2MARKET OVERVIEW. 52 5.2.1 Overview by Segment. 52 5.2.2 Overview by Anatomy 57 5.3MARKET ANALYSIS AND FORECAST .... 59 5.3.1 Total Locking Plate and Screw Market . 62 5.3.1.1 Locking Plates and Screws by Fragment Size ...64 5.3.1.1.1 Large Fragment Locking Plates and Screws.64 5.3.1.1.2 Small Fragment Locking Plates and Screws .66 5.3.1.1.3 Mini Fragment Locking Plates and Screws ...68 5.3.2 Total Standard Plate and Screw Market 70 5.3.2.1 Standard Plates and Screws by Fragment Size .72 5.3.2.1.1 Large Fragment Standard Plates and Screws ......72 5.3.2.1.2 Small Fragment Standard Plates and Screws74 5.3.2.1.3 Mini Fragment Standard Plates and Screws .76 5.3.3 Total Hybrid Plate and Screw Market ... 78 5.3.3.1 Hybrid Plates and Screws by Fragment Size.....80 5.3.3.1.1 Large Fragment Hybrid Plates and Screws...80 5.3.3.1.2 Small Fragment Hybrid Plates and Screws ...82 5.3.3.1.3 Mini Fragment Hybrid Plates and Screws.....84 5.3.4 Distal Radius Plate Market...... 86 5.4MARKET DRIVERS AND LIMITERS . 88 5.4.1 Market Drivers.... 88 5.4.2 Market Limiters... 88 5.5 COMPETITIVE ANALYSIS . 88 BIOABSORBABLE FIXATION MARKET...... 89 6.1 INTRODUCTION .. 89 6.1.1 Product Overview ...... 89 6.1.2 Disadvantages Compared to Metal Fixation 90 6.1.2.1 Expense......91 6.1.2.2 Sterilization91 6.1.2.3 Decreasing Strength with Absorption..91 6.1.2.4 Instrumentation.91 6.1.2.5 Soft Tissue Reaction and Bone Lysis ...91 6.1.3 Future Directions 91 6.2MARKET ANALYSIS AND FORECAST .... 93 6.3MARKET DRIVERS AND LIMITERS . 96 6.3.1 Market Drivers.... 96 6.3.2 Market Limiters... 96

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>> Get this Report Now by email! 6.4 COMPETITIVE ANALYSIS . 98 INTRAMEDULLARY NAIL MARKET .. 101 7.1 INTRODUCTION 101 7.1.1 Product Description. 101 7.1.2 Efficacy ...... 101 7.2MARKET OVERVIEW...... 102 7.2.1 Overview by Segment...... 102 7.2.2 Overview by Anatomy ..... 106 7.3MARKET ANALYSIS AND FORECAST .. 108 7.3.1 Intramedullary Nail Market by Indication.. 110 7.3.1.1 Femoral Intramedullary Nail Market 110 7.3.1.2 Tibial Intramedullary Nail Market ....112 7.3.1.3 Humeral Intramedullary Nail Market114 7.3.1.4 Ankle Intramedullary Nail Market.....116 7.3.1.5 Forearm Intramedullary Nail Market118 7.4MARKET DRIVERS AND LIMITERS ...... 120 7.4.1 Market Drivers.. 120 7.4.2 Market Limiters. 120 7.5 COMPETITIVE ANALYSIS ...... 121 CANNULATED SCREW MARKET . 123 8.1 INTRODUCTION 123 8.1.1 Product Description. 123 8.1.1.1 Headed Cannulated Screws.123 8.1.1.2 Headless Cannulated Screws......123 8.2MARKET OVERVIEW...... 124 8.2.1 Overview by Segment...... 124 8.2.2 Overview by Anatomy ..... 128 8.3MARKET ANALYSIS AND FORECAST .. 130 8.3.1 Total Headed Cannulated Screw Market.... 132 8.3.1.1 Headed Cannulated Screws by Size...134 8.3.1.1.1 Large Headed Cannulated Screws (Diameter > 6 mm) ...134 8.3.1.1.2 Medium Headed Cannulated Screws (Diameter 4 mm ' 6 mm).....136 8.3.1.1.3 Small Headed Cannulated Screws (Diameter 8.3.2 Total Headless Cannulated Screw Market . 140 8.3.2.1 Headless Cannulated Screws by Size.142 8.3.2.1.1 Large Headed Cannulated Screws (Diameter > 6 mm) ...142 8.3.2.1.2 Medium Headed Cannulated Screws (Diameter 4 mm ' 6 mm).....144 8.3.2.1.3 Small Headed Cannulated Screws (Diameter 8.4MARKET DRIVERS AND LIMITERS ...... 148 8.4.1 Market Drivers.. 148 8.4.2 Market Limiters. 148 8.5 COMPETITIVE ANALYSIS ...... 149 INTRAMEDULLARY HIP SCREW MARKET.... 151 9.1 INTRODUCTION 151 9.1.1 Product Description. 151 9.1.2 Efficacy ...... 151 9.2MARKET ANALYSIS AND FORECAST .. 152 9.3MARKET DRIVERS AND LIMITERS ...... 154 9.3.1 Market Drivers.. 154 9.3.2 Market Limiters. 154

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>> Get this Report Now by email! 9.4 COMPETITIVE ANALYSIS ...... 155 CONVENTIONAL HIP SCREW MARKET... 160 10.1 INTRODUCTION ..... 160 10.1.1 Product Description...... 160 10.1.2 Efficacy .... 160 10.2MARKET ANALYSIS AND FORECAST 161 10.3MARKET DRIVERS AND LIMITERS .... 163 10.3.1 Market Drivers 163 10.3.2 Market Limiters...... 163 10.4 COMPETITIVE ANALYSIS .... 164 STAPLE FIXATION MARKET.. 170 11.1 INTRODUCTION ..... 170 11.1.1 Product Description...... 170 11.1.2 Efficacy .... 170 11.2MARKET ANALYSIS AND FORECAST 171 11.3MARKET DRIVERS AND LIMITERS .... 173 11.3.1 Market Drivers 173 11.3.2 Market Limiters...... 173 11.4 COMPETITIVE ANALYSIS .... 174 BONE PIN MARKET..... 179 12.1 INTRODUCTION ..... 179 12.1.1 Product Description...... 179 12.1.2 Efficacy .... 179 12.2MARKET ANALYSIS AND FORECAST 180 12.3MARKET DRIVERS AND LIMITERS .... 182 12.3.1 Market Drivers 182 12.3.2 Market Limiters...... 182 12.4 COMPETITIVE ANALYSIS .... 183 EXTERNAL FIXATION MARKET.. 188 13.1 INTRODUCTION ..... 188 13.1.1 Product Description...... 188 13.1.2 Efficacy .... 188 13.1.3 Radiolucency... 188 13.1.4 Reusability ...... 188 13.2MARKET ANALYSIS AND FORECAST 188 13.2.1 Total External Fixation Market .. 188 13.2.2 External Fixation Market by Anatomy...... 190 13.2.2.1 Shoulder External Fixation190 13.2.2.2 Forearm External Fixation192 13.2.2.3 Wrist/Hand/Finger External Fixation ....194 13.2.2.4 Hip External Fixation .196 13.2.2.5 Upper Leg External Fixation....198 13.2.2.6 Knee External Fixation......200 13.2.2.7 Lower Leg External Fixation....202 13.2.2.8 Ankle External Fixation.....204 13.2.2.9 Foot and Toe External Fixation ......206 13.3MARKET DRIVERS AND LIMITERS .... 208 13.3.1 Market Drivers 208

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>> Get this Report Now by email! 13.3.2 Market Limiters...... 208 13.4 COMPETITIVE ANALYSIS .... 208 LONG BONE STIMULATOR MARKET 213 14.1 INTRODUCTION ..... 213 14.1.1 Product Description...... 213 14.1.2 Efficacy .... 213 14.1.3 External versus Internal Devices 214 14.1.4 FDA Classification 215 14.2MARKET OVERVIEW.... 216 14.3MARKET ANALYSIS AND FORECAST 220 14.3.1 Total Long Bone Stimulator Market .. 220 14.3.1.1 External Long Bone Stimulators......222 14.3.1.2 Internal Long Bone Stimulators226 14.4MARKET DRIVERS AND LIMITERS .... 228 14.4.1 Market Drivers 228 14.4.2 Market Limiters...... 229 14.5 COMPETITIVE ANALYSIS .... 230 ABBREVIATIONS... 234

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