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5 Questions on Engineering, Extremities and Experience with Paragon 28's CTO

Not everyone can credit a decades-long successful career to their dog. But Frank Bono, CTO and CO-Founder of Paragon 28, Inc., does exactly that.

Mr. Bono earned his undergraduate degree in mechanical engineering from Purdue University and then spent six years in the aerospace industry on the West Coast, where he contracted with the U.S. Navy. He was pursuing his graduate degree in mathematics when his dog, Spike, decided to jump over a balcony, resulting in broken carpals.

The dog needed surgery, which was more expensive than Mr. Bono could afford at the time while working part-time and attending graduate school. He paid it off in installments, and at one point, sold his motorcycle to make a payment.

“I was always taught to pay my debt,” Mr. Bono said. “I told my vet that I sold my motorcycle to pay off what I owed him, and I still owed him a few hundred more dollars after that day.”

The vet asked Mr. Bono to come in that Saturday to work off the rest. Bono showed up wearing an AC/DC t-shirt and torn jeans, expecting to be cleaning out kennels.

“He says, ‘Are those clothes clean?’ And I said, ‘Yeah, they’re clean. They’re just a little raggedy.’ And he says, ‘Well, my anesthesiologist called off, and I want you to hand me instruments while I monitor the machine and do surgery—a hip surgery on a dysplastic German shepherd.’ ”

Mr. Bono scrubbed in with the vet, and his life was forever changed. He asked the vet if the German shepherd’s surgery was similar to the procedures that were performed on humans. The vet said absolutely, and Bono’s fascination with orthopedics was solidified.

“I went back to the University of Arizona on Monday,” Mr. Bono said. “I was well over halfway through my master’s program in mathematics and immediately changed it to mechanical engineering with a biomaterials focus, then graduated and shortly thereafter took a job with DePuy Orthopaedics in 1991.”

Five years later, Mr. Bono came across boxes of small plates and screws that were in perfect condition but were mismarked or mislabeled and subsequently scrapped by DePuy. After receiving ”permission” to take them, he boxed them up and sent them to the vet’s office with a letter explaining that Spike had recently passed away and that he appreciated what they did for him, and how it changed his career path to orthopedics.

“When people bring in their pets, a lot of them can’t afford plates and screws and things,” Mr. Bono said. “If they ever had anybody who couldn’t pay for their dog or cat there, here’s a whole box of plates and screws. What comes around, goes around. And that’s how I got into orthopedics; it was my dog.”

From there, Mr. Bono’s career accelerated to leadership positions in major corporations and entrepreneurial endeavors. He started at DePuy in hips, then was one of the first few engineers for DePuy’s new spine division, DePuy Motech. He left DePuy in 2002 and became one of the co-founders of Spine Wave in Shelton, Connecticut.

Just over a year later, he was recruited to work for Medtronic Sofamor Danek in Memphis, Tennessee, where he was the Vice President of R&D for Core Spine. Several years after that, he was asked to be CTO of Wright Medical, where he spent the next four-and-a-half years. From there, he co-founded a small contract manufacturing company in Costa Rica, making pedicle screws.

In late 2011, he joined Paragon 28 with Albert DaCosta, Lee Rosenthal and Jim Riegler, who had started the company the prior year. The first time they turned a profit was 13 months later, and it was $34, barely enough for two pizzas (which Mr. Bono purchased and let the CFO know afterward). Today, the company has over 175 employees and a presence in 19 countries.

We talked with Mr. Bono about his career and asked him to share his experience and insight.

1. You worked with startups, but spent much of your career in corporate leadership positions. What was it like to be involved in a startup later in your career?

Mr. Bono: What was interesting for me is that when Paragon 28 came about 20 years after I started my orthopedic career, I was able to be an engineer again. That was extremely exciting to me, because we were starting up, and I was able to leverage 20-plus years of personal relationships without the bureaucracy of the corporate environment. The role also included quality, regulatory, compliance and even purchasing! It was exciting to hire other engineers, get the quality program going and handle regulatory and procurement. My only fear was that we were going to run out of money. Definitely makes you work at 110% capacity all day, every day.

I think it is beneficial for a startup to have those friends and contacts in the industry who can help guide you. That has helped me, and I believe helped with the early success of Paragon 28 in the functions that I oversaw.

2. What is the most important lesson you’ve learned in business?

Mr. Bono: You mean besides not burning any bridges? Hire people not because you think you need to hire someone, but because you absolutely have to. Don’t hire too quickly. Do their job first. When you’re at a point where there are not enough hours in the day, then you hire another individual.

By doing their job before you hire them, you know exactly what you’re looking for in a candidate. Try to hire people with relevant experiences, whether they come from the ortho industry or manufacturing industry.

Also, have a good mentoring program; not all engineers have the same skill sets or desires. That’s key.

3. What opportunities do you see in orthopedics over the next several years?

Mr. Bono: Extremities is experiencing an enormous double-digit growth period. Extremities, to me, is the last orthopedic frontier where there’s still a lot of opportunity for innovation and improved surgical outcomes. This is still an underserved market for many physicians. In the reconstructive business, foot and ankle doctors used to take first-generation trauma plates and bend them to make them fit the patient’s foot.

In the last several years, we actually developed dozens of procedure-specific implants. There’s still a lot of room for research, innovation, development and greatly improved surgical outcomes. This unique opportunity reminds me of spine 25 years ago.

4. Do you have any advice for people who seek to get into orthopedics and are just starting off in their careers?

Mr. Bono: If you are truly going to be in orthopedics as an engineer, my advice is to get your undergrad degree in mechanical engineering, not just biomedical engineering. I’ve found that biomedical undergrads do not have an adequate educational background in strength of materials, mechanical testing and design for manufacturing. I rarely hire someone with an undergrad in biomedical engineering. If you have a biomedical master’s degree, that’s great. But for undergrad, I think you miss out; we’re not developing pacemakers for orthopedic surgeons.

5. Who have you looked up to throughout your career, and why?

Mr. Bono: I was very fortunate to have many mentors in my career, probably because I never stayed at one company or division for a very long time. During my early career, I learned many things from different managers and directors—sometimes learning how to handle a situation, and most importantly how not to handle a situation. The mentors, who managed people well, were team players and set realistic expectations, and were the ones I tended to gravitate toward. As you grow to certain levels in many organizations, you very quickly see the politics. I avoided those relationships and the associated malarkey, sometimes to my detriment.

Taking small positives from all of them in some ways creates a unique management philosophy.

The full article can be found at

Heather Tunstall is an ORTHOWORLD Contributor.