Trauma in Extremities! PearlDiver Analysis of Market Trends

The treatment of fractures, the most common injury to bones, continues to be a consistent market in orthopedics year after year. More than 30 million patients annually visit their physicians in the United States for fracture-related injuries. Out of those 30 million, almost half (48.8%) undergo surgery or medical procedures.  These 30 million cases include fractures to shoulders, hips, knees, feet, ankles, wrists, ulnas, and all other bones in the body.  This analysis, however, will concentrate on the extremities portion of fracture incidents within the PearlDiver Patient Record Database (PRD).

Diagnoses Volume

The PearlDiver Patient Record Database is an orthopedic database consisting of over 136 million patient records collected by United HealthCare. It contains records of patients up to 65 years of age and represents an accurate sample of the national market. Chart 1 shows the number of fracture-related incidents that occurred in different extremities as well as the total number of diagnoses from 2004 through 2007.

Chart 1: Total Number of Incidents and # of Fracture-Related Incidents in Extremities
Source: PearlDiver Patient Record Database 2004-2007

The numbers in red represent the number of fracture-related diagnoses in each area. Injuries to the clavicle and scapula are included in the shoulder section while injuries to the radius and ulna are included in the wrist and forearm category.  Fractures of the feet and ankles have the highest number of incidents followed by fractures of the wrists and forearms coming in at a close second.

According to the PRD, the number of patients with bone fractures has been rising at a consistent and steady rate from 2004 through 2007. Over the span of these four years, the number of patients with scapula and clavicle fractures increased by 24.3 %, and the number of patients with humerus and elbow fractures increased by 27.5%.  Wrist and forearm fractures experienced a 20.1% growth, hand and finger fractures grew by 27.4%, and fractures of feet and ankles grew by 28.5%. The table below shows the number one fracture diagnoses in each area. A closed fracture of the metatarsal bone is the most common fracture in the extremities, while a distal end fracture of the radius is a close second.

Table 1: Most Common Fracture Diagnoses in Extremities
Source: PearlDiver Patient Record Database 2004-2007

Bones break in patients of all ages. The PRD shows that fractures are as apt to occur to a youngster as they are to a 60-year old. Table 2 shows fracture-related incidents broken down by age ranges.

Table 2: Trauma Diagnoses in Extremities by Age Breakdown
Source: PearlDiver Patient Record Database 2004-2007

Fractures also occur to men and women alike. Males account for 51.6% of patients with fractures, and females account for the remaining 48.4%. However, in the five areas of extremities, male patients account for 71.1% of clavicle and scapula injuries, 70.2% of hand and fingers injuries, and 54.5% of wrists injuries (including the radius and ulna). Females account for 59.6% of foot and ankle fractures and 51.8% of humerus and elbow injuries.

Procedure Volume

How often are fractures treated and what are the common fracture procedures in these five categories of extremities?  According to the PRD, almost 35% of patients undergo some treatment after injuring their extremities. Chart 2 shows how often the fractures are treated based on the number of diagnoses reported.

Chart 2: Fracture Treatments in Extremities
Source: PearlDiver Patient Record Database 2004-2007

Wrist and forearm fractures, including the radius and ulna, are the most commonly treated injuries according to the PRD database. Almost 39.2% of the diagnosed wrist and forearm patients are treated with either closed or open fracture treatments. About 32.7% of patients with foot and ankle fractures undergo medical procedures, while fractures in the categories of hands and fingers, humerus and elbows, and shoulder fractures are treated at the rate of 24.7%, 31.5% and 30.4%, respectively.  The most used procedure in all five areas of extremities is a closed treatment.

Table 3 contains patient data on procedures from 2004 to 2007.

Table 3: Most Common Fracture Procedures in Extremities
Source: PearlDiver Patient Record Database 2004-2007

Table 4 shows the age range of patients who underwent procedures for fractures of their extremities between the years 2004 through 2007.

Table 4: Trauma Procedures in Extremities by Age Breakdown
Source: PearlDiver Patient Record Database 2004-2007

Procedures on the humerus and wrists were most often performed on patients under the age of 10, while treatments for fractures of shoulders, hands and fingers were performed most often on patients between the ages of 10 and 30. Patients between ages 45 and 65 received the most treatment for feet and ankle fractures. Female patients make up 50.6% of those who underwent procedures for fractures. Males dominate the categories of shoulder and hand/finger procedures with 70.3% and 66.3% respectively, while females lead with procedures on wrist and forearm fractures (53.6%), humerus fractures (55.7%) and ankle fractures, (60%).

Market Overview

Synthes holds 43.2% of the total market in bone fracture related treatment. Following Synthes at a distant second is Stryker with 15.4% of the market. Smith and Nephew hold the third position with 10.8% of the total market. Table 5 shows the worldwide revenue market for the major trauma companies.

Table 5: Trauma Companies Worldwide Revenue 2004-2007 ($ in Millions)
Source: Companies' SEC Filings

Synthes, which is growing at a 15% rate, is recognized as the number one trauma company in the world. Smith and Nephew and Stryker are experiencing positive growth rates of 19.3% and 18.8%, respectively. The total market growth in 2007 was 14.1% year-over-year, which is up from the 13.2% year-over-year growth rate in 2006.

Even though the market does not separate out bone fracture treatments in the extremities, an overwhelming majority of the market is involved with treating the extremities. The almost half a million patients undergoing treatment for extremities fractures in the PearlDiver database translates to over 10 million patients nationwide. With surgeons interested in less invasive procedures and devices such as the locking plate and screw systems, the trauma market should expect a steady growth of 10% to 12% over the next five years.