Orthopaedic Fixation: Past, Present and Future -- MEDICA Trade Fair

Orthopaedic surgery was awakened as a speciality during World War I, and particularly driven by the units in Great Britain directed at the care of injured servicemen. The developments in orthopaedic surgery today are a result of the experiences during war times. Dr. Kunchner from Germany was the first person to use intramedullary rods for the treatement of fractures. Soon it was discovered that this method speeded up the recovery time of German soldiers and subsequently was adopted as a standard method of treatment world wide. The external fixation of fractures was refined by American surgeons after the Vietnma War but a major contribution for the methodology used today in the external fixation arena was made by Grigor Ilizarov in the previous USSR in the 1950’s. Confronted with no equipment and responsible of treating cripplicng conditions of unhealed, infected and malalinged fractures, he decided to improvise and devised a ring external fixator which resembled the spokes of a bicycle. This device successfully enabled healing and realinging of fractures and is still used today in a more refined version.

The main aim of fracture treatment is to restore skeletal movement to its optimal fumction. Surgeons are responsible for getting the fracture to heal as soon as possible and at the same time minimize soft-tissue complications. Immobilisation or fixation of the bone has proved to help healing and reduce the risk of damaging the nerves and blood vessels.

The trauma fixation instrumentation includes metal plates, nails, screws, pins, wire and other components which can be used internally or externally. The external fixation systems include a stabilizing metal frame with braces which connect to pins which are drilled into the bones. This allows the reposition of the bone fragments and over a period of time helps them to heal. The external fixation systems are not a solution to fracture management and typically used in conjunction with internal fixation and other types of treatment. The type of fracture or musculoskeletal disease and the surgeon’s preference are the primary determinants of the course of treatment taken.

The total European market in 2004 was estimated to be $1,665.7million of which trauma products accounted for 23% of the sales. Trauma products are estimated to grow by 3 % per cent annually due to several macro environmental drivers present in the healthcare industry.

The most important drivers for the orthopaedic trauma products are the increasing ageing population which correlates with the increase of age-related diseases especially in the industrialized nations.

Non invasive treatment is generally preferred in most European countries. The length of stay in hospitals for patients receiving non invasive treatment is significantly less, hence reducing overall costs for orthopaedic related treatments.

Restraints that affect the growth for the orthopaedic fixation products include poor reimbursement structures. Germany and Austria are some of the countries in Europe where trauma treatment is associated with a lot of kudos and this is reflected in good reimbursement values. In other European countries payment for fixation procedures is extrapolated from other orthopaedic budgets such as the prosthetic or hip and knee. In most of the European countries and particularly in Sweden, clinical trials play a pivotal role in the decision making process for reimbursements of fixation products and can often lead to choosing an alternative method of treatment as a result of insufficient clinical evidence.

The market for trauma is very niche with three major players dominating the European market. Frost & Sullivan estimates that the market for fixation is dominated by three main players. Stryker is estimated to dominate the market, followed by Smith and Nephew, and De Puy which operates under the Johnson and Johnson brand. Synthes- Stratec is a very strong niche player in the fixation industry within Europe and a leading medical device company which particularly focuses on the development and manufacturing of market instruments, implants, biomaterials and surgical fixation.

Fixation products could be segmented into two main categories the internal and external fixation market. The internal fixation market can be sub-segmented into nails and plates. The external fixation products can be sub segmented into Unilateral, Bilateral, Hybrid, Colles (Wrist), Pelvic Circular systems.

Technological development of internal fixation products are thought to be somewhat restricted and it is envisaged that better designing of the plates or the type of materials used could alter with the help of computer aided designs (CAD) and computer aided manufacturing (CAM). There is a general trend towards an uptake of more titanium components as they provide the same level of strength when compared to other metals and offer greater biocompatibility. It is believed that the cost containment strategies implemented by governments would impact the traditional methods of fixation treatment used today. Alternative methods of treating orthopaedic fixation indications will emerge, which will significantly reduce patient recovery time and overall costs for healthcare providers. Minimal invasive surgeries and greater uptake of minimal invasive plates are expected to take place.

The market for fixation products is heavily consolidated but there are still opportunities for smaller key industry participants to leverage sales particularly in niche orthopaedic areas. This is expected to drive innovation and development for orthopaedic fixation systems.

Healthcare containment strategies, increasing cost pressures and greater uptake of less invasive treatments are envisaged to change fixation treatment methodologies in the future. Technological advances of biomaterials could revolutionaries and reform fixation methodologies as known today.

For further information please contact:

Radhika Menon Theodore
Corporate Communications
+91 44 52044668