Key Factors Limiting Europe’s Intramedullary Nail Market

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Intramedullary Nail Market: What's Limiting Growth in Europe?

Europe’s market for intramedullary nails experienced a substantial decline in 2020, following COVID-19 and restrictions associated with social distancing. Unfortunately, the market has yet to recover and indicates clear signs of a decrease into 2026 to reach €97.8 million.


Intramedullary nails (IM nails) are solid or cannulated metal rods typically used to align and stabilize fractures. IM nails share the weight load with the bone rather than supporting the fracture, giving them an advantage over any alternative method. IM nails are inserted into the length of long bones and are held in place by cortical screws. The screws pass through the outer cortex layer of bone and into the nail. These devices are typically less invasive than plates and screws and have been growing in popularity to replace plate fixation. Early IM nails were triangular or had a V-shaped cross-section, but they were subsequently altered to the current, more rotationally stable clover-leaf structure. 



One of the significant limiters within this market is the inevitable presence of competition. There are three types of competition in this market: Tender competition, intra-market competition, and inter-market competition. 

Tender competition refers to the purchasing of products by bodies governed by public law. These tenders can open up competitive contracts to vendors who can then compete based on price, quantity, and type of goods. There is heavy public procurement in many European countries, and as a result, prices for IM nail devices are under intense negative pressure. 

Intra-market competition is present as vendors offer highly specialized anatomically specific nails for several indications, which produce downward pressure on average selling prices. 

Inter-market competition occurs between external fixation devices and intramedullary nails. Surgeons favor external fixation devices for the treatment of trauma fractures and present themselves as a competitive alternative. 


In May of 2020, the European Union (EU) decided to implement recently approved new medical device regulations. Some of the changes include the Unique Device Identification and the higher standards required when introducing a new device to the market. These rules apply to all incoming and current devices within the EU. As a result, suppliers will set higher product prices for new devices entering an already intense market. In the past, the European market was relatively easy to enter and was a great place for introducing new products. With the new rules, and the difficulty surrounding introducing new products, innovation will likely decline. 

3. COVID-19

COVID-19 did have an impact on this market and its growth, mainly throughout 2020. One of the major trauma centers in England with a capacity of over 800 beds and with over 680,000 patients seen per year reported a significant reduction in the number of traumatic injuries during the lockdown. Observations suggest that there was a significant decrease in road traffic collisions involving cars during the lockdown, while bike-related accidents increased. An overall decline in the orthopedic device market in Europe during the COVID-19 pandemic was due to restrictions associated with social distancing, resulting in limited outdoor activities and social events and, in turn, fewer severe traumas. 


One of the main components creating potential opportunities for growth within the intramedullary nail market would be demographic factors. With an aging population and a growing number of obese individuals, there are rising risks for bone fractures. An increase in bone fractures, particularly hip fractures in the aging population, will fuel demand for fixation devices. 

Other factors are similarly at play, such as favorable clinical outcomes, growth in the ankle and femoral nail segments, and differentiation in instrumentation. However, these do not appear to be sufficient enough to encourage growth. 

Further Insights on the Intramedullary Nail and Orthopedic Trauma Device Markets


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Emma MatrickKey Factors Limiting Europe’s Intramedullary Nail Market