Hodling Fast

Now remember, with every blow of the hammer, you’ve got to feel the femoral nail advancing through the bone. If you don’t, then for heaven’s sake, stop. It might be impinging on the cortex or it might be too large for the canal. Keep whacking, and you’ll fracture the cortex. ” The trainer’s calm, authoritative voice boomed out across the room as a dozen orthopedic surgeons toiled away on the cadaver limbs laid out before them. Pausing to observe the technique of one of the surgeons, he glanced up to see his boss, CEO Peter Walsh, crack open the door and squeeze through, trying his best to be unobtrusive.

The trainer glanced at the clock. “Okay, let’s save some of this fun for the afternoon,” he called out. “We’ll meet in the lobby in ten minutes and walk over to lunch. ” In addition to making a range of products from artificial hips to scalpels, Crescordia was one of a handful of major companies that developed, manufactured, and sold the steel and titanium plates, nails, and screws—known as fixation devices—that surgeons used to repair broken bones. At least twice a month, Crescordia hosted training sessions like this one for orthopedic surgeons who used the company’s products.

Walsh joined the group for lunch as often as possible. It was a great opportunity to connect with the physicians and hear firsthand what they liked and didn’t like about Crescordia’s products. Besides, he just plain enjoyed their company. Trauma surgeons tended to be brilliant but down to earth. With their hammers, saws, and drills, they were as much carpenters as they were doctors. Maybe because so many of the cases they saw were the result of bad luck, they had a certain perspective on the world.

They tended to joke a lot when they got together, and if you could tolerate some morbid humor you found yourself laughing along. After the air-conditioned chill and formaldehyde odor of the lab, the heat of the summer day was a welcome change. Strolling along the paved path to the cafeteria, one of the surgeons launched into an account of a difficult case he’d seen that week. “Get this: The guy’s a conductor—you know, with a symphony orchestra—so he really needs that wrist action. ” The surgeon flicked an imaginary baton upward by way of illustration.

“So, of course, what does he manage to break his very first time on Rollerblades? ” Walsh winced in sympathy. “On top of that, it’s the same wrist he fractured five years ago, falling off his podium—and it was fixed that time with a distal radius plate. ” The rest of the group made sympathetic noises; no one liked having to remove old plates to implant new ones. “But wait—it gets worse. He’s from Europe, just came here last year. And his surgeon must have fancied himself on the leading edge, because that plate was resorbable. Or, shall we say, it was supposed to be. ”

Now a great groan went up from the group, to the clear satisfaction of the surgeon. Everyone had a mental image of what he must have encountered, and it wasn’t pretty. The idea behind resorbable hardware was a good one. Like dissolving sutures, resorbable plates and screws were made of biodegradable polymers that held up long enough to do their job—to support a healing bone—then gradually disintegrated harmlessly into the patient’s body. The first and second generations of the technology were far from perfect, though, as the surgeon’s case and many like it made clear.

After five years, there should have been nothing left of the plate in the conductor’s wrist—the key words being “should have. ” “Let me guess,” another doctor chimed in. “It looked like the hull of the Titanic in there. ” He sighed and shook his head. “And who knows if the resorbables on the market today are any better? ” Walsh stiffened slightly and cleared his throat, anticipating what would come next. Sure enough, someone posed the question right away. “So, when is Crescordia going to make a resorbable fixation system? You guys would do it right. Finally, I’d have the confidence to use the darn things on a regular basis.

” Everyone looked at Walsh, but his response was as noncommittal as ever. “I wish we could give it to you today. But believe me, the science just isn’t there yet. There’s a reason those products are so buggy. And we wouldn’t waste your time selling them to you. Our reputation—and yours—means too much to us. ” Walsh then adroitly shifted the topic to what Crescordia would introduce next, and the conversation moved on. He relaxed again when they arrived at the bustling cafeteria and he could play host, offering pointers on what the various stations had to offer.

As the trainees reconvened at the dining tables, Walsh sized up his seating options. Taking care not to spill his soup, he squeezed past a table with a group debating World Series prospects and joined a couple of surgeons who were obviously talking shop. One of them was using his turkey roll-up to describe a femur fracture he’d recently fixed. “So right here’s where the blade plate had to go in,” he was saying as he pressed a plastic knife through the pita. The fellow beside him interrupted. “And we’re in a lateral position, right? ”

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