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A Look into Trauma Trends: Surgeon and Industry Perspective

Trauma is the third largest market segment by product sales in the global orthopaedic industry at 15 percent of the whole, trailing spine (18 percent) and joint replacement (34 percent), according to ORTHOWORLD® estimates. The segment stands to experience further growth as population numbers increase and people face age-related injuries.

According to surgeons and industry interviewed by BONEZONE, trends in trauma center on the rise in hip fractures, challenges of treating osteoporosis and pelvis fractures, the emergence and need for specialty plates and a place for biologics to enhance bone healing.

First, we present viewpoints from three orthopaedic trauma surgeons:

Eric E. Johnson, M.D., orthopaedic trauma surgeon at Ronald Reagan UCLA Medical Center
Heather A. Vallier, M.D., orthopaedic trauma surgeon at MetroHealth and member of the Orthopaedic Trauma
Association’s Board of Directors
Joel C. Williams, M.D., trauma specialist, Midwest Orthopaedics at Rush

BONEZONE: What trends do you see in products or procedures for the trauma market?

Eric-Johnson-M.DJohnson: The biggest thing in the last five years is osteoporotic fractures. Hospitals are overwhelmed with hip fractures. We see seven or eight times as many as we did 20 years ago. A lot of initiatives are addressing ways to maximize and treat these patients.

In the last ten years, I’ve noticed locking plate fixation technology. We can take care of osteoporotic fractures now much more easily, because these fixed implants don’t loosen. The bone can heal within the time that the plate is in place, so we don’t have failures.

For osteoporotic fractures, especially in shoulder or tibia plateau fractures, screws can be cannulated, locked and have a blunt tip. You can put the screw into the system in a bad area of bone, as long as you don’t penetrate the opposite side into the joint. Then, you infuse a phosphate-type biomaterial through the screw that spreads out into the head and occupies space, so the screw doesn’t loosen. Hip fractures can be treated with more confidence that it’s not going to fall apart because you can fill the area around the implant inside the femoral head, giving more stability.

Heather-Vallier-M.D. webjpgVallier: There’s been a push toward specialty plate systems, as opposed to traditional plates which we would contour and modify ourselves. It’s challenging, because there are so many different plates out there now. You don’t necessarily need a specific plate for every area. Finding that balance of versatility of traditional implants, as opposed to having to add more trays and stock—whether it’s owned or consigned by hospitals—is a challenge.

If you don’t keep all those things in your hospital, then when you have a distal humerus fracture [to treat], it’s a lot of running around for implant vendors to make sure things are processed out beforehand. People don’t plan to get hurt, so you can’t book it on the schedule two or three weeks ahead of time. For smaller hospitals it’s even more pressure to figure out how to have sets that are configured to treat a lot of body areas well without needing a lot of extra add-ons.

Some things that could be improved upon might be in the use of biologics. Bone and cartilage healing and repair are areas that are not currently met biologically. I see a lot of potential in the next several years.