Brian Thornes, X-Bolt Trauma Therapeutics - Studio Interview | LSI Europe ‘22


Brian Thornes

Brian Thornes

CEO, X-Bolt Trauma Therapeutics
Read Biography
CEO, Brian Thornes and X-Bolt Trauma Therapeutics are developing next-generation devices for use during trauma surgeries. Key to the company's portfolio of orthopedic products are its expanding bolt design and the ability to easily reverse and remove implanted devices.


Nick Talamantes  0:00  

Brian, thank you so much for joining me here at LSI Europe. Tell me first a little bit about yourself.


Brian Thornes  0:04  

So my background, I'm an orthopedic surgeon by training. And my career path, I guess was was wanting to be in orthopedic surgery. And on that early journey, I had a, I guess, the light bulb moment for ankle fractures. What I what I saw on in my early practice only resident that for a certain subset of ankle fractures, you needed to come back for a second surgery. And I thought this is the 21st century is bonkers. The call centers, Moses injuries, and the way they're usually treated was putting a screw across the two bones. And when the patients then rehabbed the bone, the screw would toggle and either break loose, or surgeons will elect to take it out. I think this this is nuts, you know, like, yeah, we need to do something better than that. So the solution to that was putting two buttons on either side of the ankle, pulling suture tight between the two bones, and we call it the tight rope or substance, we call it the tight rope. And I went and develop that and did a small clinical trial in Ireland, and patients had really well. And then companies were I pitched it to every company that that would listen to me. And I ended up signing a contract with Arthrex in Naples, Florida. And the tightrope just took off from there.


Nick Talamantes  1:28  

Tell me a bit about your company. 


Brian Thornes  1:32  

So Tightrope. Sorry, Tightrope isn't isn't the company. So title was my first my my first success. And although it was a little bit of struggle on the way, it was really enjoyable journey for me, and I thought I wanted to replicate this. So it was always on the lookout, really, for other problems in orthopedics. And the big problem, I think, that most orthopedic surgeons would recognize is osteoporosis. So osteoporosis is when the bones get weak in older people, and cause them to fracture a little bit more easily. But by the same token, when you put in any implant, particularly a screw into osteo, product bone, it toggles and comes loose. So it's very hard to get fixation. And you can do things like put in extra polymers or cement, or use bigger implants or do other ways around it. But um, so one of the innovation that the second lightbulb moment for me is when I was putting a, an expanding bolt into the wall, I was putting up a TV screen on my apartment well, and I think why this is so simple, why don't we have this in orthopedics. And that was the lightbulb moment, and, and we went forth with that. So the biggest the biggest problem, or the biggest manifestation for osteoporosis, hip fractures, and hip fractures are in a very elderly population, it's in the 80s, and 90s. And people will probably have stories that their grandmother or their, you know, aunts friend, or whatever, they fell at home, and they broke their hip, and they're never quite right afterwards. And they had a very dependent lifestyle. And, you know, until they until they died, and it's very unfortunate that it is, it is one of the last things, you know, that happens to very frail, mostly women. I just felt, you know, in the hospital, if they can be treated better, you can actually give them a better chance and they're sort of autumn of their of their lives and mobilize them a little bit better and not have the complications of a failed hip surgery.


Nick Talamantes  3:23  

That's great. You're using technology to improve quality of life for those that are truly in need of it. Almost, you know, as you said, they were enjoying movement, an accident, unfortunately happens. It's not just osteo osteoporosis and also degenerative diseases, but stroke to my grandfather, he had a stroke. And while he was in the hospital, he fell, broke his hip. 


Brian Thornes  3:46  

Oh my goodness. 


Nick Talamantes  3:47  

Yeah. So it's would this technology be applicable there? Or is there Yeah, would you


Brian Thornes  3:53  

so it's like it's more prevalent in women one in six women will actually get a hip fracture in their lifetime. So it's more a woman is more likely to get a hip fracture in her life than she has breast cancer but yet breast cancer gets the you know, hits the hits the headlines a bit more. And even in hospitals, you know, the the they're usually very elderly and have other medical conditions which takes I guess it takes some of the the emphasis or the the sympathy away for them if that's the case. But if you treat them well, if you if you fix it properly with proper implants and mobilize them properly, they get out of hospital more, they're less likely to have then problems with pneumonias, leg ulcers, DVTs, and they're less costly overall, the cost for a patient episode for a hip fracture is $50,000 for the for the for the indexing, but if it goes wrong, it's an additional $40,000 On average for for the for for when it goes wrong. So if you can prevent any of these problems, you'll not only save the patients and their families About hardship, but also save a lot of money in the process.


Nick Talamantes  5:03  

So what's the current standard of care for patients that, you know, they they break their hip because of osteoporosis? What are they doing? And how is your technology sort of innovating or changing the what, you know, the paradigm perhaps, of how you treat these patients?


Brian Thornes  5:19  

Yeah. Well, similarly, the way that the tightrope actually changed tightrope was a very simple device. I mean, you think about it, I mean, a lot of people would say, Oh, why didn't I think of that before. And similarly, with the export, it's going from a screw to an expanding bullet. So it's not a huge jump in changing the whole paradigm of surgery. But the great thing about an expanding bolt is that the standard of care is usually putting a nail down through through the femur, and then putting the shooting the screw up through the nail, and holding into the femoral head. But the great thing about the expanding bolt is each shoot the bolts through the nail, but then it expands on the far side, so you get a much bigger fixation, you can use the full real estate of the femoral head to get your fixation there. And the great thing about the technology, then it's also applicable for other areas in the body that have osteoporosis, like the spine, the distal femur, proximal humerus. So we've adapted our technology now to to, to go into other areas.


Nick Talamantes  6:12  

That's incredible. What is the export made out of?


Brian Thornes  6:15  

So it's very simple. We started off with stainless steel, now we make it in titanium. There's there's quite a lot of internal engineering that makes it sort of smart. And that's, we've spent a lot of time designing that when we went it took about two years to go from stainless steel to to titanium, it was it was a little bit of a struggle at times, but the end product, we were happy that it is a very simple product for the surgeon to use. And so they don't have to worry about what the internal engineering is all about. They just take a screwdriver, open it up. And then if there's a problem, he put a screwdriver in again and then turn it down into collapses down, you can take it out. So you're always surgeons always in control of where where they're at with the with the product.


Nick Talamantes  6:57  

Tell us how it works. You've got to you've got your bolt, X bolt, correct? Yep, right here. How does it work.


Brian Thornes  7:03  

So this, this is one of the competitors screws. So that's the standard screw that will go into, you know, the type of thing that would go into normal hip fractures up into up into the femoral head. And this is the expanding bolt. Now it comes in its collapse state goes in, and then with a screwdriver up the back end, it opens up these four wings. And it's four rings, because you can always see that on AP and lateral X rays. And it's like it gives the surgeon total control. If there's a problem, they can pull it back and collapse it down.


Nick Talamantes  7:35  

That's great to see it in person here, what is the market opportunity look like for this technology.


Brian Thornes  7:40  

So the market for hip fracture, so our lead products, the hip fracture market, we do have coming in underneath a lot of the other areas that I said, but just looking at the hip fracture market alone it is it is just short of a billion dollar market. And a the main players in it are Cynthia, Stryker, and Smith and Nephew. And they they dominate the market. But there are a number of other players, tier two players that are that are getting in and doing other trauma products. And we've spoken to a lot of them. I think they like our technology. They're certainly looking at it. And again, going back to the tightrope, the tightrope was had the monopoly of the of what it does. And now all those big players are copying tightrope. So I think that export will change the standard of care, it's moving evolutionary from a screw to an expanding bolt that it gives, it gives them a better fixation in these in these fractures.


Nick Talamantes  8:35  

Your previous technology was acquired by Arthrex. Is acquisition or exit? Is that sort of the strategy right now for export? Or is it to continue to scale up? Tell me a bit about what the strategy is?


Brian Thornes  8:49  

Sure. So our company for we've been around for about 15 years, and we've in an r&d company, we've done clinical trials, we did two big clinical trials, actually here in the UK. One, the first one was was 100 patients. And the second one then was over 1000 patients, which actually was the largest ever hip fracture fixation trial in the world was randomized control trial. And it compared our exports against the screw, and we came out better. And we had less cut out complications cut out as when the screw or the bolt cuts out of the femoral head literally just cuts out. It's like if you're pulling a screw out, it's the same thing. But it's not compatible then, with walking around because you have this screw that's essentially scraping on your hip every time you walk. So you necessitate a second operation. And that's the big problem that we're trying to to get around. So we have the number of cutouts versus a screw. And even in the trials, the two groups actually are quite low cut out rates. So we're half that of the screw in the trial, but we're 75% less than what would be deemed the running average of of cut out rates


Nick Talamantes  9:55  

Is cut out, is that a pretty common complication then it's seen


Brian Thornes  9:59  

A lot because hip arches are, most hospitals would probably do one hip fracture a day, your typical hospital would do 200 300 cases a year. So they just come in, day out day after day. Thankfully, thankfully, they don't all arrive on one day. But sometimes you do get a run and hip fractures. But it is a constant number of hip fractures done day in day out. So actually, when you see that volume, and it's three and a half percent or that the correct rate. So it's something that that surgeons would see reasonably often, like three or four times a year that they'd probably see it. So I mean, that kind of they used to it. And there's there is a bailout plan. But like I said, it costs about $40,000 of additional costs, and the patient is yet more debilitated because they're, they're frail. They're, you know, they've had one operation, they're even frailer because of that, and then they have a problem. And then they have a second operation, you know, really puts them down at a really at a disadvantage.


Nick Talamantes  10:58  

So as a surgeon, have you actually implanted your own technology and patients,


Brian Thornes  11:03  

I have assisted on them. I haven't actually, I've done cadaver courses, but I have had other surgeons then put it in on my behalf. But it is quite I you know, when you say that actually is, you know, there's the warm, fuzzy feeling you have on the birth of a child, I've had that sort of warm, fuzzy feeling twice now. Because I actually did the very first tightrope operation, I remember it, and it was a December 2004. And nobody else cared in the whole operating theater. And I was really excited for the first time I've ever going in. And you know, sure enough, it went very well. And it's all you know, internal glow. And I was, you know, it was the same thing for the very first X-Bolt to go in. It was it was a friend of mine, friend of mine who was a surgeon who was putting it in, but you know, the same warm, fuzzy feeling knowing that you had the first and man of the product that you invented.


Nick Talamantes  11:57  

I can't even imagine what it feels like to see your product being actually utilized. 


Brian Thornes  12:02  

Oh, it's amazing. It's amazing. And then you hear stories. I gave a story and my pitch. Dave Grohl of Foo Fighters. He's got one of my tightrope in him. No, no, yeah. So it was it. People might have heard the story. So he was playing in Gothenburg and in Sweden, and he fell off stage. He was at the beginning of a set. And he was he was down there. And so I think I broke my leg. And sure enough, he had, but they they want you to reel him off. He said, No, no, no, I've got to continue to set. So he was there. He was strapped up and he was still rocking away. So we did 26 songs, with his leg strapped up. And then after it was all over the car from after hospital. But then he tweeted that on his on the Foo Fighters, Twitter thing off his fixation. And people were I didn't see this all happening. But I was I was shown his Twitter thanks to your title open. It's got your title. That's cool.


Nick Talamantes  12:55  

That's incredible. Well, we're here at LSI Europe, what brings you to this event?


Brian Thornes  13:00  

So we are we're, like I said, we're an r&d company, by and large. And we've gone through all these clinical trials and FDA approvals and the like, and we're looking to engage and network with some of the investors that are here and the strategics. Like, so we have talking to a number of strategics. But it's an ongoing kind of process with them, de risking the product and in our journey. So we are looking to network and and get a investment round to commercialize this in the US.


Nick Talamantes  13:31  

Exciting. So you're in Are you currently in Europe then?


Brian Thornes  13:34  

We are currently in the UK and Ireland. Okay. And we're looking to launch in the US pretty early next year. Yes, we will probably just, we will probably just stay focused geographically in one small area to begin with, okay, and


Nick Talamantes  13:46  

Then build your sales


Brian Thornes  13:47  

And build out from there. But we you know, again, if there's the excitement levels are the same as what was with the tight rope and the ice hockey hockey stick curve going up? I think that we might attract a bit of attention.


Nick Talamantes  13:58  

Well, Brian, thank you so much for telling me a bit about your story and your company. Pleasure. 


Brian Thornes  14:02  

Yeah, thank you very much indeed.


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