Orthofix Medical (OFIX) 10-Q 3 Nov 15 2015 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2015	Oct. 30, 2015
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2015
Document Fiscal Year Focus	2,015
Document Fiscal Period Focus	Q3
Trading Symbol	OFIX
Entity Registrant Name	ORTHOFIX INTERNATIONAL N V
Entity Central Index Key	884,624
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Entity Common Stock, Shares Outstanding		18,889,815

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Current assets:
Cash and cash equivalents	$ 63,694	$ 36,815
Restricted cash		34,424
Trade accounts receivable, less allowance for doubtful accounts of $7,153 and $7,285 at June 30, 2015 and December 31, 2014, respectively	56,173	61,358
Inventories	57,766	59,846
Deferred income taxes	35,974	37,413
Prepaid expenses and other current assets	31,884	26,552
Total current assets	245,491	256,408
Property, plant and equipment, net	51,467	48,549
Patents and other intangible assets, net	5,368	7,152
Goodwill	53,565	53,565
Deferred income taxes	19,101	18,541
Other long-term assets	27,457	8,970
Total assets	402,449	393,185
Current liabilities:
Trade accounts payable	17,009	13,223
Other current liabilities	61,570	53,220
Total current liabilities	78,579	66,443
Deferred income taxes		229
Other long-term liabilities	26,664	26,886
Total liabilities	$ 105,243	$ 93,558
Contingencies (Note 11)
Shareholders’ equity:
Common shares $0.10 par value; 50,000,000 shares authorized; 18,839,335 and 18,611,495 issued and outstanding as of June 30, 2015 and December 31, 2014, respectively	$ 1,888	$ 1,861
Additional paid-in capital	239,954	232,788
Retained earnings	59,182	65,360
Accumulated other comprehensive loss	(3,818)	(382)
Total shareholders’ equity	297,206	299,627
Total liabilities and shareholders’ equity	$ 402,449	$ 393,185

Condensed Consolidated Balance3

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Statement Of Financial Position [Abstract]
Trade accounts receivable, allowance for doubtful accounts	$ 9,468	$ 7,285
Common shares, par value	$ 0.10	$ 0.10
Common shares, authorized	50,000,000	50,000,000
Common shares, issued	18,882,661	18,611,495
Common shares, outstanding	18,882,661	18,611,495

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive (Loss) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Income Statement [Abstract]
Product sales	$ 87,761	$ 88,296	$ 251,461	$ 265,175
Marketing service fees	13,390	12,698	40,406	36,818
Net sales	101,151	100,994	291,867	301,993
Cost of sales	23,865	25,268	65,114	77,455
Gross profit	77,286	75,726	226,753	224,538
Operating expenses
Sales and marketing	46,129	40,998	133,360	124,182
General and administrative	19,348	19,322	63,423	55,396
Research and development	6,523	6,572	18,819	18,818
Restatements and related costs	1,147	2,326	9,276	12,959
Total operating expenses	73,147	69,218	224,878	211,355
Operating income	4,139	6,508	1,875	13,183
Other income and expense
Interest expense, net	(125)	(395)	(323)	(1,355)
Other expense, net	(1,736)	(1,322)	(192)	(1,231)
Total other income (expense)	(1,861)	(1,717)	(515)	(2,586)
Income before income taxes	2,278	4,791	1,360	10,597
Income tax expense	(3,066)	(4,763)	(5,808)	(9,251)
Net (loss) income from continuing operations	(788)	28	(4,448)	1,346
Discontinued operations
(Loss) income from discontinued operations	(804)	260	(2,315)	(6,363)
Income tax benefit	221	164	585	2,278
Net (loss) income from discontinued operations	(583)	424	(1,730)	(4,085)
Net (loss) income	$ (1,371)	$ 452	$ (6,178)	$ (2,739)
Net (loss) income per common share—basic:
Net (loss) income from continuing operations	$ (0.04)		$ (0.24)	$ 0.07
Net (loss) income from discontinued operations	(0.03)	$ 0.02	(0.09)	(0.22)
Net (loss) income per common share—basic:	(0.07)	0.02	(0.33)	(0.15)
Net (loss) income per common share—diluted:
Net (loss) income from continuing operations	(0.04)		(0.24)	0.07
Net (loss) income from discontinued operations	(0.03)	0.02	(0.09)	(0.22)
Net (loss) income per common share—diluted:	$ (0.07)	$ 0.02	$ (0.33)	$ (0.15)
Weighted average number of common shares:
Basic	18,855,533	18,577,540	18,785,696	18,408,238
Diluted	18,855,533	18,773,386	18,785,696	18,564,522
Other comprehensive loss:
Unrealized (loss) gain on derivative instruments, net of tax	$ (706)	$ 112	$ 230	$ 184
Foreign currency translation adjustment	(365)	(3,302)	(3,666)	(2,728)
Comprehensive loss	$ (2,442)	$ (2,738)	$ (9,614)	$ (5,283)

Condensed Consolidated Stateme5

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014
Cash flows from operating activities:
Net cash provided by operating activities	$ 26,236	$ 35,966
Cash flows from investing activities:
Capital expenditures for property, plant and equipment	(20,980)	(11,324)
Capital expenditures for intangible assets	(219)	(170)
Net proceeds from sale of assets	4,800
Purchase of other investments		(1,457)
Purchase of debt securities	(15,250)
Net proceeds from sale of other investments		32
Net cash used in investing activities	(31,649)	(12,919)
Cash flows from financing activities:
Net proceeds from issuance of common shares	1,669	10,333
Repayment of long term debt, net		(20,000)
Payment of debt issuance costs	(1,723)
Changes in restricted cash	34,424	(11,023)
Excess income tax benefit on employee stock-based awards	303	202
Net cash provided by (used in) financing activities	34,673	(20,488)
Effect of exchange rate changes on cash	(2,381)	(1,658)
Net increase in cash and cash equivalents	26,879	901
Cash and cash equivalents at the beginning of the period	36,815	28,924
Cash and cash equivalents at the end of the period	$ 63,694	$ 29,825

Nature of operations, basis of

Nature of operations, basis of presentation and recently issues accounting pronouncements	9 Months Ended
	Sep. 30, 2015
Organization Consolidation Basis Of Presentation Business Description And Accounting Policies [Abstract]
Nature of operations, basis of presentation and recently issues accounting pronouncements	1. Nature of operations, basis of presentation and recently issues accounting pronouncements Nature of operations Orthofix International N.V. (together with its subsidiaries, the “Company”) is a diversified, global medical device company focused on developing and delivering innovative repair and regenerative technologies to the spine and orthopedic markets. The Company is comprised of four reportable segments: BioStim, Biologics, Extremity Fixation and Spine Fixation supported by corporate activities. Basis of presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States (“U.S. GAAP”) for interim financial information and with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X. Pursuant to these rules and regulations, certain information and note disclosures normally included in financial statements prepared in accordance with U.S. GAAP have been condensed or omitted. In the opinion of management, all adjustments (consisting of normal recurring items) considered necessary for a fair statement have been included. These condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and related notes contained in the Company’s Annual Report on Form 10-K for the year ended December 31, 2014 (the “2014 Form 10-K”). The preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. On an ongoing basis, the Company evaluates its estimates including those related to revenue recognition, contractual allowances, doubtful accounts, inventories, potential goodwill and intangible asset impairment, fair value measurements, litigation and contingent liabilities, income taxes, and shared-based compensation. Actual results could differ from these estimates. As permitted under U.S. GAAP, interim accounting for certain expenses, including income taxes, are based on full year forecasts. For interim financial reporting purposes, income taxes are recorded based upon estimated annual effective income tax rates taking into consideration discrete items occurring during the period. Recently issued accounting standards In April 2014, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2014-08, Reporting Discontinued Operations and Disclosures of Components of an Entity. In May 2014, the FASB issued ASU 2014-09, Revenue from Contracts with Customers In April 2015, the FASB issued ASU 2015-03, Interest – Imputation of Interest (Subtopic 835-30): Simplifying the Presentation of Debt Issuance Costs, Interest – Imputation of Interest (Subtopic 835-30): Presentation and Subsequent Measurement of Debt Issuance Costs Associated with Line-of-Credit Arrangements In July 2015, the FASB issued ASU 2015-11, Simplifying the Measurement of Inventory

Inventories

Inventories	9 Months Ended
	Sep. 30, 2015
Inventory Disclosure [Abstract]
Inventories	2. Inventories The Company’s inventories are primarily stated at standard cost, which approximates actual cost determined on a first-in, first-out basis. Work-in-process and finished products include material, labor and production overhead costs. Finished products include field inventory which represents immediately saleable finished products that are in the possession of the Company’s direct sales representatives, and consignment inventory which represents immediately saleable finished products located at third party customers, such as distributors and hospitals. Deferred cost of sales result from transactions where the Company has shipped product or performed services for which all revenue recognition criteria have not been met. Once the revenue recognition criteria have been met, both the revenues and associated cost of sales are recognized. Inventories were as follows: (U.S. Dollars, in thousands) September 30, 2015 December 31, 2014 Raw materials $ 3,344 $ 3,879 Work-in-process 5,156 4,830 Finished products 44,691 45,612 Deferred cost of sales 4,575 5,525 Total inventory $ 57,766 $ 59,846

Long-term debt

Long-term debt	9 Months Ended
	Sep. 30, 2015
Debt Disclosure [Abstract]
Long-term debt	3. Long-term debt On August 31, 2015, the Company, through its subsidiaries Orthofix Holdings, Inc. (“Orthofix Holdings”) and Victory Medical Limited (“Victory Medical”, and collectively with Orthofix Holdings, the “Borrowers”), entered into a Credit Agreement (the “New Credit Agreement”) with JPMorgan Chase Bank, N.A. (“JPMorgan”), as Administrative Agent, and certain lenders party thereto. The New Credit Agreement provides for a five year $125 million secured revolving credit facility (the “Facility”) and replaces the Company’s prior 2010 credit facility, which expired and matured pursuant to its terms on August 30, 2015 with no amounts outstanding. As of September 30, 2015, the Borrowers have not made any borrowings under the New Credit Agreement. Borrowings under the New Credit Agreement may be used for, among other things, working capital and other general corporate purposes (including share repurchases, permitted acquisitions and permitted payments of dividends and other distributions) of the Company and certain of its subsidiaries. The Facility is generally available in U.S. Dollars with up to $50 million of the Facility also available to be borrowed in Euros and Pounds Sterling (together with U.S. Dollars, the “Agreed Currencies”). The New Credit Agreement further permits up to $50 million of the Facility to be utilized for the issuance of letters of credit in the Agreed Currencies. The Borrowers have the ability to increase the amount of the Facility by an aggregate amount of up to $50 million (which increase may take the form of one or more increases to the revolving credit commitments and/or the issuance of one or more new Term A loans) upon satisfaction of certain conditions precedent and receipt of additional commitments by one or more existing or new lenders. Borrowings under the Facility bear interest at a floating rate, which is, at the Borrowers option, either LIBOR plus an applicable margin ranging from 1.75% to 2.5% or a base rate plus an applicable margin ranging from 0.75% to 1.5% (in each case subject to adjustment based on the Company’s total leverage ratio). An unused commitment fee ranging from 0.25% to 0.4% (subject to adjustment based on the Company’s total leverage ratio) is payable quarterly in arrears based on the daily amount of the undrawn portion of each lender’s revolving credit commitment under the Facility. Fees are payable on outstanding letters of credit at a rate equal to the applicable margin for LIBOR loans, plus certain customary fees payable solely to the issuer of the letter of credit. The Company and certain of its subsidiaries (collectively, the “Guarantors”) are required to guarantee the repayment of the Borrowers’ obligations under the New Credit Agreement. The obligations of the Borrowers and each of the Guarantors with respect to the New Credit Agreement are secured by a pledge of substantially all of the tangible and intangible personal property of the Borrowers and each of the Guarantors, including accounts receivable, deposit accounts, intellectual property, investment property, inventory, equipment and equity interests in their subsidiaries. The New Credit Agreement contains customary affirmative and negative covenants, including limitations on the Company’s and its subsidiaries’ ability to incur additional debt, grant or permit additional liens, make investments and acquisitions, merge or consolidate with others, dispose of assets, pay dividends and distributions, repay subordinated indebtedness and enter into affiliate transactions. In addition, the New Credit Agreement contains financial covenants requiring the Company on a consolidated basis to maintain, as of the last day of any fiscal quarter, a total leverage ratio of not more than 3.0 to 1.0 and an interest coverage ratio of at least 3.0 to 1.0. The Company was in compliance with all required financial covenants at September 30, 2015. The New Credit Agreement also includes events of default customary for facilities of this type, and upon the occurrence of such events of default, subject to customary cure rights, all outstanding loans under the Facility may be accelerated and/or the lenders’ commitments terminated. In conjunction with obtaining the Facility, the Company incurred debt issuance costs of $1.7 million which are being amortized over the life of the Facility. The debt issuance costs are included in other long-term assets, net of accumulated amortization. All debt issuance costs relating to the prior 2010 credit facility have been fully amortized. The Company had no borrowings and an unused available line of credit of €5.8 million ($6.5 million and $7.0 million) at September 30, 2015 and December 31, 2014, respectively, on its Italian line of credit. This unsecured line of credit provides the Company the option to borrow amounts in Italy at rates which are determined at the time of borrowing.

Derivative instruments

Derivative instruments	9 Months Ended
	Sep. 30, 2015
Derivative Instruments And Hedging Activities Disclosure [Abstract]
Derivative instruments	4. Derivative instruments The tables below disclose the types of derivative instruments the Company owns, the classifications and fair values of these instruments within the balance sheet, and the amount of gain (loss) recognized in other comprehensive income (loss). (U.S. Dollars, in thousands) As of September 30, 2015 Fair f (unfavorable) Balance sheet location Cross-currency swap $ 4,633 Other long-term assets Warrants $ 311 Other long-term assets As of December 31, 2014 Cross-currency swap $ 2,504 Other long-term assets Warrants $ 321 Other long-term assets Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2015 2014 2015 2014 Cross-currency swap unrealized gain (loss) recorded in other comprehensive income (loss), net of taxes $ (706 ) $ 112 $ 230 $ 184 Warrants unrealized gain recorded in other comprehensive income (loss), net of taxes $ — $ — $ — $ —

Fair value measurements

Fair value measurements	9 Months Ended
	Sep. 30, 2015
Fair Value Disclosures [Abstract]
Fair value measurements	5. Fair value measurements The fair value of the Company’s financial assets and liabilities on a recurring basis were as follows: (U.S. Dollars, in thousands) Balance September 30, 2015 Level 1 Level 2 Level 3 Assets Collective trust funds $ 1,622 $ — $ 1,622 $ — Treasury securities 518 518 — — Certificates of deposit 594 594 — — Derivative securities 4,944 — 4,944 — Equity securities 1,457 — 1,457 — Debt securities 15,694 — — 15,694 Total $ 24,829 $ 1,112 $ 8,023 $ 15,694 Liabilities Deferred compensation plan $ (1,554 ) $ — $ (1,554 ) $ — Total $ (1,554 ) $ — $ (1,554 ) $ — (U.S. Dollars, in thousands) Balance December 31, 2014 Level 1 Level 2 Level 3 Assets Collective trust funds $ 1,696 $ — $ 1,696 $ — Treasury securities 586 586 — — Certificates of deposit 1,510 1,510 — — Derivative securities 2,825 — 2,825 — Equity securities 1,457 — 1,457 — Total $ 8,074 $ 2,096 $ 5,978 $ — Liabilities Deferred compensation plan $ (1,886 ) $ — $ (1,886 ) $ — Total $ (1,886 ) $ — $ (1,886 ) $ — Debt Securities On March 2015, Company Option Agreement (the “Option Agreement”) with eNeura, Inc. (“eNeura”), privately technology company devices treatment migraines. The Option Agreement provides the Company an exclusive acquire eNeura (the “Option”) during 18-month following grant the Option. consideration for the Option, (i) Company non-refundable $0.3 million fee eNeura, and eNeura issued Convertible Promissory Note “eNeura Note”) Company. The principal of the eNeura Note $15.0 million interest accrues at The eNeura Note will mature earlier (i) March 4, exercise of the Option. The investment is recorded in other long-term assets as an available for sale debt security and interest is recorded in interest income. The fair value of the instrument is based upon significant unobservable inputs, requiring the Company to develop its own assumptions; therefore, the Company has categorized this asset as a Level 3 financial asset. As of September 30, 2015, the Company believes the carrying amount of the investment and accrued interest approximates fair value. The following table provides a reconciliation of the beginning and ending balances for debt securities measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2015 Balance at January 1 $ — Additions to debt securities 15,000 Accrued interest income 694 Balance at September 30 $ 15,694

Accumulated other comprehensive

Accumulated other comprehensive loss	9 Months Ended
	Sep. 30, 2015
Equity [Abstract]
Accumulated other comprehensive loss	6. Accumulated other comprehensive loss Accumulated other comprehensive loss is comprised of foreign currency translation adjustments, the effective portion of the gain (loss) on the Company’s cross-currency swap, which is designated and accounted for as a cash flow hedge, and the unrealized gain (loss) on warrants. The components of and changes in accumulated other comprehensive loss were as follows: (U.S. Dollars, in thousands) Foreign Currency Translation Adjustments Change in Fair Value Accumulated Other Comprehensive Loss Balance at December 31, 2014 $ (482 ) $ 100 $ (382 ) Unrealized gain on derivative instruments, net of tax of $130 — 230 230 Foreign currency translation adjustment (1) (3,666 ) — (3,666 ) Balance at September 30, 2015 $ (4,148 ) $ 330 $ (3,818 ) (1) As the unremitted earnings generally remain indefinitely reinvested in the non U.S. dollar denominated foreign subsidiaries, no deferred taxes are recognized on the related foreign currency translation adjustment.

Earnings per share

Earnings per share	9 Months Ended
	Sep. 30, 2015
Earnings Per Share [Abstract]
Earnings per share	7. Earnings per share For the three and nine months ended September 30, 2015 and 2014, there were no adjustments to net income (loss) for purposes of calculating basic and diluted net income (loss) available to common shareholders. The following is a reconciliation of the weighted average shares used in the basic and diluted net loss per common share computations. Three Months Ended September 30, Nine Months Ended September 30, 2015 2014 2015 2014 Weighted average common shares-basic 18,855,533 18,577,540 18,785,696 18,408,238 Effect of dilutive securities: Unexercised stock options net of treasury share repurchase — 195,846 — 156,284 Weighted average common shares-diluted 18,855,533 18,773,386 18,785,696 18,564,522 Performance-based restricted stock awards and options to purchase shares of common stock with exercise prices in excess of the average market price of common shares are not included in the computation of diluted earnings per share. There were 998,992 and 942,366 outstanding awards and options not included in the diluted earnings per share computation for the three and nine months ended September 30, 2015, respectively, because their inclusion was antidilutive. There were 1,023,038 and 1,055,422 outstanding awards and options not included in the diluted earnings per share computation for the three and nine months ended September 30, 2014, respectively, because their inclusion was antidilutive. Due to the Company being in a net loss from continuing operations position for the three and nine months ended September 30, 2015, no adjustment has been made for potentially dilutive shares totaling 204,432 and 211,397 for any common stock equivalents as their effects would be antidilutive for the quarterly and year-to-date periods, respectively.

Share-based compensation

Share-based compensation	9 Months Ended
	Sep. 30, 2015
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Share-based compensation	8. Share-based compensation All share-based compensation costs are measured at the grant date, based on the estimated fair value of the award, and are recognized as expense in the condensed consolidated statements of operations over the requisite service period. The Company recognized $1.9 million and $5.5 million of share-based compensation expense for the three and nine months ended September 30, 2015, and $1.7 million and $4.1 million for the three and nine months ended September 30, 2014. On June 30, 2014, the Company granted 99,600 performance-based restricted share awards to officers and certain employees. Vesting is based on achieving earnings targets in two consecutive rolling four quarter periods. As of September 30, 2015, no expense has been recognized for these contingent restricted share awards. On June 30, 2015, the Company granted 68,750 performance-based restricted share awards to officers and on August 5, 2015, granted an additional 41,910 performance-based restricted share awards to other members of management. Vesting is based on achieving earnings and return on invested capital targets as of and for the years ended December 31, 2016, 2017 or 2018. As of September 30, 2015, no expense has been recognized for these contingent restricted share awards. During the three and nine months ended September 30, 2015, there were 43,326 and 271,166 shares, respectively, of common stock issued related to stock purchase plan issuances, stock option exercises and the vesting of restricted stock awards. During the three and nine months ended September 30, 2014, there were 69,572 and 501,862 shares, respectively, of common stock issued related to stock purchase plan issuances, stock option exercises and the vesting of restricted stock awards.

Income taxes

Income taxes	9 Months Ended
	Sep. 30, 2015
Income Tax Disclosure [Abstract]
Income taxes	9. Income taxes In the third quarter, our effective tax rate on continuing operations was 134.6%, or $3.1 million, as compared to 99.4%, or $4.8 million, for the same period in the prior year. Excluding the impact of various discrete charges, the effective tax rate on continuing operations for the third quarter of 2015 and 2014 was 63.3% and 74.7%, respectively. In the first nine months of 2015, our effective tax rate on continuing operations was 427.0%, or $5.8 million, as compared to 87.3%, or $9.3 million, for the same period in the prior year. Excluding the impact of various discrete charges, the effective tax rate on continuing operations for the first nine months of 2015 and 2014 was 279.2% and 68.4%, respectively. The Company’s effective tax rate for the three and nine month periods ended September 30, 2015 was impacted by recording a valuation allowance on the net deferred tax assets in Puerto Rico in response to recent fiscal and economic difficulties experienced by the Puerto Rico Commonwealth, the Company’s mix of earnings among various tax jurisdictions, state taxes, and current period losses in certain jurisdictions for which the Company does not currently receive a tax benefit. During the third quarter of 2015, the Internal Revenue Service commenced an examination of our federal income tax return for 2012. The State of Massachusetts also commenced an examination of our state income tax returns for 2012 and 2013. The Company cannot reasonably determine if these examinations will have a material impact on our financial statements and cannot predict the timing regarding resolution of those tax examinations. As of September 30, 2015 and December 31, 2014, the Company’s unrecognized tax benefit was $15.5 million and $15.6 million, respectively. The Company had approximately $0.5 million accrued for payment of interest and penalties as of September 30, 2015 and December 31, 2014. It is reasonably possible that the amount of the unrecognized benefit with respect to certain of our unrecognized tax positions will significantly increase or decrease within the next 12 months. These changes may be the result of settlements of ongoing audits, competent authority proceedings or other events. At this time, an estimate of the range of the reasonably possible outcomes cannot be made.

Business segment information

Business segment information	9 Months Ended
	Sep. 30, 2015
Segment Reporting [Abstract]
Business segment information	10. Business segment information The Company has four strategic business units (“SBUs”), which are comprised of BioStim, Biologics, Extremity Fixation, and Spine Fixation supported by corporate activities. The primary metric used in managing the Company is net margin, which is defined as gross profit less sales and marketing expense. The Company neither discretely allocates assets, other than goodwill, to its operating segments nor evaluates the operating segments using discrete asset information. The tables below present net sales for continuing operations by SBU reporting segment. Net sales include product sales and marketing service fees. Marketing service fees, which are recorded on a net basis, are comprised of fees earned for the marketing of Trinity Evolution ® ® Three Months Ended September 30, (U.S. Dollars, in thousands) 2015 2014 Reported Increase (Decrease) Constant Currency Increase (Decrease) BioStim $ 41,559 $ 38,285 8.6 % 8.6 % Biologics 14,639 13,856 5.7 % 5.7 % Extremity Fixation 24,694 27,636 (10.6 )% 3.4 % Spine Fixation 20,259 21,217 (4.5 )% (3.9 )% Total net sales $ 101,151 $ 100,994 0.2 % 4.1 % Nine Months Ended September 30, (U.S. Dollars, in thousands) 2015 2014 Reported Increase (Decrease) Constant Currency Increase (Decrease) BioStim $ 119,962 $ 114,937 4.4 % 4.4 % Biologics 43,874 40,718 7.8 % 7.8 % Extremity Fixation 72,103 82,005 (12.1 )% 2.1 % Spine Fixation 55,928 64,333 (13.1 )% (12.6 )% Total net sales $ 291,867 $ 301,993 (3.4 )% 0.6 % The table below presents net margin by SBU reporting segment: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2015 2014 2015 2014 BioStim $ 16,834 $ 16,442 $ 47,634 $ 49,168 Biologics 6,296 6,504 19,525 19,500 Extremity Fixation 6,442 8,361 22,607 21,952 Spine Fixation 1,938 3,958 4,582 11,147 Corporate (353 ) (537 ) (955 ) (1,411 ) Total net margin 31,157 34,728 93,393 100,356 General and administrative 19,348 19,322 63,423 55,396 Research and development 6,523 6,572 18,819 18,818 Restatements and related costs 1,147 2,326 9,276 12,959 Operating income $ 4,139 $ 6,508 $ 1,875 $ 13,183

Contingencies

Contingencies	9 Months Ended
	Sep. 30, 2015
Commitments And Contingencies Disclosure [Abstract]
Contingencies	11. Contingencies The Company is party to outstanding legal proceedings, investigations and claims, as previously described in (i) Part I, Item 3, “Legal Proceedings,” of the 2014 Form 10-K and (ii) note 15 to the Company’s audited consolidated financial statements filed with the 2014 Form 10-K. The Company believes that it is unlikely that the outcome of any of these matters will have a material adverse effect on it and its subsidiaries as a whole, notwithstanding that the unfavorable resolution of any matter may have a material effect on the Company’s net earnings (if any) in any particular quarter. However, the Company cannot predict with any certainty the final outcome of any of these legal proceedings, investigations (including any settlement discussions with the government seeking to resolve such investigations) or claims, and there can be no assurance that the ultimate resolution of any such matters will not have a material adverse impact on the Company’s consolidated financial position, results of operations, or cash flows. We record accruals for certain outstanding legal proceedings, investigations or claims when it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. We evaluate, on a quarterly basis, developments in legal proceedings, investigations and claims that could affect the amount of any accrual, as well as any developments that would make a loss contingency both probable and reasonably estimable. When a loss contingency is not both probable and reasonably estimable, we do not accrue the loss. However, if the loss (or an additional loss in excess of the accrual) is at least a reasonable possibility and material, then we disclose a reasonable estimate of the possible loss or range of loss, if such reasonable estimate can be made. If we cannot make a reasonable estimate of the possible loss, or range of loss, then that is disclosed. In addition to the matters described in the paragraphs below and in the 2014 Form 10-K, in the normal course of its business, the Company is involved in various lawsuits from time to time and may be subject to certain other contingencies. To the extent losses related to these contingencies are both probable and reasonably estimable, the Company accrues appropriate amounts in the accompanying financial statements and provides disclosures as to the possible range of loss in excess of the amount accrued, if such range is reasonably estimable. The Company believes losses with respect to these additional matters are individually and collectively immaterial as to a possible loss and range of loss. Matters Related to the Audit Committee’s Review and the Restatement of Certain of our Consolidated Financial Statements. Audit Committee Review In July 2013, the Audit Committee of our Board of Directors began conducting an independent review, with the assistance of outside professionals, of certain accounting matters. This review resulted in a restatement of our previously filed consolidated financial statements for the years ended December 31, 2012, 2011 and 2010 and the quarter ended March 31, 2013, as well as the restatement of certain financial information for the years ended December 31, 2009, 2008 and 2007. This restatement, which we completed and filed in March 2014, is referred to herein as the “Original Restatement.” In connection with the Company’s preparation of its consolidated interim quarterly financial statements for the quarter ended June 30, 2014, the Company determined that certain entries with respect to the previously filed financial statements contained in the filings containing the Original Restatement were not properly accounted for under U.S. GAAP. As a result, the Company determined in August 2014 to restate its previously filed consolidated financial statements for the years ended December 31, 2013, 2012 and 2011 and quarterly reporting periods contained within the years ended December 31, 2013 and 2012, as well as the quarter ended March 31, 2014. This restatement, which we completed in March 2015, is referred to herein as the “Further Restatement.” SEC Investigation In connection with the initiation of the Audit Committee’s independent review, we initiated contact with the staff of the Division of Enforcement of the SEC (the “SEC Enforcement Staff”) in July 2013 to advise them of these matters. The Audit Committee and the Company, through respective counsel, have been in direct communication with the SEC Enforcement Staff regarding these matters. The SEC is conducting a formal investigation of these matters, and both the Company and the Audit Committee are cooperating fully with the SEC. In connection with the above-referenced communications, the Company has received requests from the SEC for documents and other information concerning various accounting practices, internal controls and business practices, and other related matters. Such requests cover the years ended December 31, 2011 and 2012, and in some instances, prior periods. It is anticipated that we may receive additional requests from the SEC in the future, including with respect to the Further Restatement. We have previously provided notice concerning our communications with the SEC to the Office of Inspector General of the U.S. Department of Health and Human Services (“HHS-OIG”) pursuant to our corporate integrity agreement with HHS-OIG. We cannot predict if, when or how this matter will be resolved or what, if any, actions we may be required to take as part of any resolution of these matters. Any action by the SEC, HHS-OIG or other governmental agency could result in civil or criminal sanctions against us and/or certain of our current and former officers, directors and employees. At this stage in the matter, we cannot reasonably estimate the possible loss, or range of loss, in connection with it. Securities Class Action Complaint On August 14, 2013, a securities class action complaint against the Company, previously styled Tejinder Singh v. Orthofix International N.V., et al., and which is now styled Plumbers & Pipefitters National Pension Fund v. Orthofix International N.V., et al., was filed in the United States District Court for the Southern District of New York arising out of the then anticipated restatement of our prior financial statements and the matters described above. Since the date of original filing, the complaint has been amended. The lead plaintiff’s complaint, as amended, purports to bring claims on behalf of persons who purchased the Company’s common stock between March 2, 2010 and July 29, 2013. The complaint asserts that the Company and four of its former executive officers, Alan W. Milinazzo, Robert S. Vaters, Brian McCollum, and Emily V. Buxton (collectively, the “Individual Defendants”), violated Section 10(b) of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), and Securities and Exchange Commission Rule 10b-5 (“Rule 10b-5”) by making false or misleading statements in or relating to the Company’s financial statements. The complaint further asserts that the Individual Defendants were liable as control persons under Section 20(a) of the Exchange Act for any violation by the Company of Section 10(b) of the Exchange Act or Rule 10b-5. As relief, the complaint requests compensatory damages on behalf of the proposed class and lead plaintiff’s attorneys’ fees and costs. On March 6, 2015, the court granted the defendants’ motion to dismiss as to Mr. Milinazzo and denied it with respect to the Company and the other Individual Defendants. On October 22, 2015, following negotiations facilitated by an independent mediator, the Company, the remaining Individual Defendants and their insurers reached an agreement in principle with the plaintiff, individually and on behalf of the class it purports to represent, to settle and release all claims with respect to this matter subject to final court approval. Under the terms of the agreement in principle, the Company, through its insurers, would make a payment to the plaintiff, and the class it purports to represent, to resolve all claims related to the matter, including any claims for plaintiff counsel’s fees and expenses. The Company has previously incurred and expensed fees and expenses in connection with this matter up to and exceeding its insurance policy deductible; as a result, the Company expects that the full amount of the settlement payment will be covered by and paid by its insurers. The parties have notified the court of the settlement in principle, and are currently drafting definitive documentation to memorialize all of the terms of the agreement in principle. The parties currently expect that the settlement documentation will be presented to the court for its review in late November 2015 or early December 2015. The Company has accrued both the amount of the settlement payment under the agreement in principle, and a corresponding insurance receivable from its insurers, with respect to these matters. However, there can be no assurance that the parties will agree on final documentation, or that the terms of the settlement will be approved by the court as proposed by the parties. In the event that the settlement were not finalized and approved on the terms agreed in principle, we cannot reasonably estimate the possible loss, or range of loss, to the Company in connection with this matter. Deferred Prosecution Agreement and Review of Potential Improper Payments Involving Brazil Subsidiary In 2012, the Company entered into definitive agreements with the U.S. Department of Justice (the “DOJ”) and the SEC agreeing to settle a self-initiated and self-reported internal investigation of our Mexican subsidiary, Promeca S.A. de C.V. (“Promeca”), regarding non-compliance by Promeca with the Foreign Corrupt Practices Act (the “FCPA”). As part of the settlement, we entered into a three-year deferred prosecution agreement (“DPA”) with the DOJ and a consent to final judgment (the “Consent”) with the SEC. In August 2013, the Company’s internal legal department was notified of certain allegations involving potential improper payments with respect to its Brazilian subsidiary, Orthofix do Brasil Ltda. The Company engaged outside counsel to assist in the review of these matters, focusing on compliance with applicable anti-bribery laws, including the FCPA. Consistent with the provisions of these agreements, the Company contacted the DOJ and the SEC in August 2013 to voluntarily self-report the Brazil-related allegations. On June 15, 2015, the Company and the DOJ agreed to extend the term of the DPA for two months (through September 17, 2015) to permit the DOJ additional time to evaluate the Company’s compliance with the internal controls and compliance undertakings in the DPA and to further investigate the Brazil-related allegations. On September 17, 2015, the DOJ extended the term of the DPA for an additional ten months (through July 17, 2016), stating that the Company’s efforts to comply with the internal controls and compliance requirements of the DPA during the first eighteen months of the DPA were insufficient. The Company and its counsel remain in contact with both agencies regarding the status of the review and cannot reasonably estimate any possible loss, or range of loss, in connection with the review, including any effects it may have with respect to the DPA and Consent. Matters Related to the Company’s Former Breg Subsidiary and Possible Indemnification Obligations On May 24, 2012, we sold Breg to an affiliate of Water Street Healthcare Partners II, L.P. (“Water Street”) pursuant to a stock purchase agreement (the “Breg SPA”). Under the terms of the Breg SPA, upon closing of the sale, the Company and its subsidiary, Orthofix Holdings, Inc., agreed to indemnify Water Street and Breg with respect to certain specified matters, including the following: · Breg was engaged in the manufacturing and sale of local infusion pumps for pain management from 1999 to 2008. Since 2008, numerous product liability cases have been filed in the United States alleging that the local anesthetic, when dispensed by such infusion pumps inside a joint, causes a rare arthritic condition called “chondrolysis.” The Company has incurred losses for settlements and judgments in connection with these matters during 2015 and 2014 of $0.3 million and $3.8 million, respectively. In addition, several cases remain outstanding for which the Company currently cannot reasonably estimate the possible loss, or range of loss. At the time of its divestiture, Breg was currently and had been engaged in the manufacturing and sales of motorized cold therapy units used to reduce pain and swelling. Several domestic product liability cases have been filed in recent years, mostly in California state court, alleging the use of cold therapy causes skin and/or nerve injury and seeking damages on behalf of individual plaintiffs who were allegedly injured by such units or who would not have purchased the units had they known they could be injured. In September 2014, the Company entered into a master settlement agreement resolving all pending pre-close claims. Pursuant to the terms of the settlement agreement, the Company paid approximately $ 1.3 million, and additional amounts owed under the settlement were paid directly by the Company’s insurance providers. These amounts paid by the Company were recorded as an expense in discontinued operations during the quarter ended June 30, 2014. Remaining cold therapy claims include a putative consumer class of individuals who did not suffer physical harm following use of the devices, and an appeal of an adverse July 2012 California jury verdict and a post-close cold therapy claim pending in California state court. As of September 30, 2015, we have an accrual of $5.7 million for the July 2012 verdict and post-close cold therapy liabilities; however, the actual liability could be higher or lower than the amount accrued. The putative class action is at an early stage and the Company currently cannot reasonably estimate the possible loss, or range of loss.

Nature of operations, basis o17

Nature of operations, basis of presentation and recently issues accounting pronouncements (Policies)	9 Months Ended
	Sep. 30, 2015
Organization Consolidation Basis Of Presentation Business Description And Accounting Policies [Abstract]
Basis of presentation	Basis of presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States (“U.S. GAAP”) for interim financial information and with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X. Pursuant to these rules and regulations, certain information and note disclosures normally included in financial statements prepared in accordance with U.S. GAAP have been condensed or omitted. In the opinion of management, all adjustments (consisting of normal recurring items) considered necessary for a fair statement have been included. These condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and related notes contained in the Company’s Annual Report on Form 10-K for the year ended December 31, 2014 (the “2014 Form 10-K”). The preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. On an ongoing basis, the Company evaluates its estimates including those related to revenue recognition, contractual allowances, doubtful accounts, inventories, potential goodwill and intangible asset impairment, fair value measurements, litigation and contingent liabilities, income taxes, and shared-based compensation. Actual results could differ from these estimates. As permitted under U.S. GAAP, interim accounting for certain expenses, including income taxes, are based on full year forecasts. For interim financial reporting purposes, income taxes are recorded based upon estimated annual effective income tax rates taking into consideration discrete items occurring during the period.
Recently issued accounting standards	Recently issued accounting standards In April 2014, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2014-08, Reporting Discontinued Operations and Disclosures of Components of an Entity. In May 2014, the FASB issued ASU 2014-09, Revenue from Contracts with Customers In April 2015, the FASB issued ASU 2015-03, Interest – Imputation of Interest (Subtopic 835-30): Simplifying the Presentation of Debt Issuance Costs, Interest – Imputation of Interest (Subtopic 835-30): Presentation and Subsequent Measurement of Debt Issuance Costs Associated with Line-of-Credit Arrangements In July 2015, the FASB issued ASU 2015-11, Simplifying the Measurement of Inventory

Inventories (Tables)

Inventories (Tables)	9 Months Ended
	Sep. 30, 2015
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories were as follows: (U.S. Dollars, in thousands) September 30, 2015 December 31, 2014 Raw materials $ 3,344 $ 3,879 Work-in-process 5,156 4,830 Finished products 44,691 45,612 Deferred cost of sales 4,575 5,525 Total inventory $ 57,766 $ 59,846

Derivative instruments (Tables)

Derivative instruments (Tables)	9 Months Ended
	Sep. 30, 2015
Derivative Instruments And Hedging Activities Disclosure [Abstract]
Schedule of Fair Values of Derivative Instruments	The tables below disclose the types of derivative instruments the Company owns, the classifications and fair values of these instruments within the balance sheet, and the amount of gain (loss) recognized in other comprehensive income (loss). (U.S. Dollars, in thousands) As of September 30, 2015 Fair f (unfavorable) Balance sheet location Cross-currency swap $ 4,633 Other long-term assets Warrants $ 311 Other long-term assets As of December 31, 2014 Cross-currency swap $ 2,504 Other long-term assets Warrants $ 321 Other long-term assets
Schedule of Gain (Loss) Recognized in Other Comprehensive Income (Loss)	Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2015 2014 2015 2014 Cross-currency swap unrealized gain (loss) recorded in other comprehensive income (loss), net of taxes $ (706 ) $ 112 $ 230 $ 184 Warrants unrealized gain recorded in other comprehensive income (loss), net of taxes $ — $ — $ — $ —

Fair value measurements (Tables

Fair value measurements (Tables)	9 Months Ended
	Sep. 30, 2015
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Schedule of Financial Assets and Liabilities Recorded at Fair Value on Recurring Basis	The fair value of the Company’s financial assets and liabilities on a recurring basis were as follows: (U.S. Dollars, in thousands) Balance September 30, 2015 Level 1 Level 2 Level 3 Assets Collective trust funds $ 1,622 $ — $ 1,622 $ — Treasury securities 518 518 — — Certificates of deposit 594 594 — — Derivative securities 4,944 — 4,944 — Equity securities 1,457 — 1,457 — Debt securities 15,694 — — 15,694 Total $ 24,829 $ 1,112 $ 8,023 $ 15,694 Liabilities Deferred compensation plan $ (1,554 ) $ — $ (1,554 ) $ — Total $ (1,554 ) $ — $ (1,554 ) $ — (U.S. Dollars, in thousands) Balance December 31, 2014 Level 1 Level 2 Level 3 Assets Collective trust funds $ 1,696 $ — $ 1,696 $ — Treasury securities 586 586 — — Certificates of deposit 1,510 1,510 — — Derivative securities 2,825 — 2,825 — Equity securities 1,457 — 1,457 — Total $ 8,074 $ 2,096 $ 5,978 $ — Liabilities Deferred compensation plan $ (1,886 ) $ — $ (1,886 ) $ — Total $ (1,886 ) $ — $ (1,886 ) $ —
Fair Value, Inputs, Level 3 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Schedule of Reconciliation of Available for Sale Debt Securities	The following table provides a reconciliation of the beginning and ending balances for debt securities measured at fair value using significant unobservable inputs (Level 3): (U.S. Dollars, in thousands) 2015 Balance at January 1 $ — Additions to debt securities 15,000 Accrued interest income 694 Balance at September 30 $ 15,694

Accumulated other comprehensi21

Accumulated other comprehensive loss (Tables)	9 Months Ended
	Sep. 30, 2015
Equity [Abstract]
Components of Changes in Accumulated Other Comprehensive Loss	The components of and changes in accumulated other comprehensive loss were as follows: (U.S. Dollars, in thousands) Foreign Currency Translation Adjustments Change in Fair Value Accumulated Other Comprehensive Loss Balance at December 31, 2014 $ (482 ) $ 100 $ (382 ) Unrealized gain on derivative instruments, net of tax of $130 — 230 230 Foreign currency translation adjustment (1) (3,666 ) — (3,666 ) Balance at September 30, 2015 $ (4,148 ) $ 330 $ (3,818 ) (1) As the unremitted earnings generally remain indefinitely reinvested in the non U.S. dollar denominated foreign subsidiaries, no deferred taxes are recognized on the related foreign currency translation adjustment.

Earnings per share (Tables)

Earnings per share (Tables)	9 Months Ended
	Sep. 30, 2015
Earnings Per Share [Abstract]
Schedule of Reconciliation of Weighted Average Shares Used in Calculation of Basic and Diluted Net (Loss) Income Per Share	The following is a reconciliation of the weighted average shares used in the basic and diluted net loss per common share computations. Three Months Ended September 30, Nine Months Ended September 30, 2015 2014 2015 2014 Weighted average common shares-basic 18,855,533 18,577,540 18,785,696 18,408,238 Effect of dilutive securities: Unexercised stock options net of treasury share repurchase — 195,846 — 156,284 Weighted average common shares-diluted 18,855,533 18,773,386 18,785,696 18,564,522

Business segment information (T

Business segment information (Tables)	9 Months Ended
	Sep. 30, 2015
Segment Reporting [Abstract]
Schedule of Net Sales by SBU Reporting Segment	The tables below present net sales for continuing operations by SBU reporting segment. Net sales include product sales and marketing service fees. Marketing service fees, which are recorded on a net basis, are comprised of fees earned for the marketing of Trinity Evolution ® ® Three Months Ended September 30, (U.S. Dollars, in thousands) 2015 2014 Reported Increase (Decrease) Constant Currency Increase (Decrease) BioStim $ 41,559 $ 38,285 8.6 % 8.6 % Biologics 14,639 13,856 5.7 % 5.7 % Extremity Fixation 24,694 27,636 (10.6 )% 3.4 % Spine Fixation 20,259 21,217 (4.5 )% (3.9 )% Total net sales $ 101,151 $ 100,994 0.2 % 4.1 % Nine Months Ended September 30, (U.S. Dollars, in thousands) 2015 2014 Reported Increase (Decrease) Constant Currency Increase (Decrease) BioStim $ 119,962 $ 114,937 4.4 % 4.4 % Biologics 43,874 40,718 7.8 % 7.8 % Extremity Fixation 72,103 82,005 (12.1 )% 2.1 % Spine Fixation 55,928 64,333 (13.1 )% (12.6 )% Total net sales $ 291,867 $ 301,993 (3.4 )% 0.6 %
Summary of Net Margin by SBU Reporting Segment	The table below presents net margin by SBU reporting segment: Three Months Ended September 30, Nine Months Ended September 30, (U.S. Dollars, in thousands) 2015 2014 2015 2014 BioStim $ 16,834 $ 16,442 $ 47,634 $ 49,168 Biologics 6,296 6,504 19,525 19,500 Extremity Fixation 6,442 8,361 22,607 21,952 Spine Fixation 1,938 3,958 4,582 11,147 Corporate (353 ) (537 ) (955 ) (1,411 ) Total net margin 31,157 34,728 93,393 100,356 General and administrative 19,348 19,322 63,423 55,396 Research and development 6,523 6,572 18,819 18,818 Restatements and related costs 1,147 2,326 9,276 12,959 Operating income $ 4,139 $ 6,508 $ 1,875 $ 13,183

Nature of operations, basis o24

Nature of operations, basis of presentation and recently issues accounting pronouncements - Additional Information (Detail)	9 Months Ended
	Sep. 30, 2015Segment
Organization Consolidation Basis Of Presentation Business Description And Accounting Policies [Abstract]
Number Of Reporting Units	4

Inventories - Schedule of Inven

Inventories - Schedule of Inventories (Detail) - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Inventory Disclosure [Abstract]
Raw materials	$ 3,344	$ 3,879
Work-in-process	5,156	4,830
Finished products	44,691	45,612
Deferred cost of sales	4,575	5,525
Total inventory	$ 57,766	$ 59,846

Long-Term Debt - Additional Inf

Long-Term Debt - Additional Information (Detail)	Aug. 31, 2015USD ($)	Sep. 30, 2015USD ($)	Sep. 30, 2015EUR (€)	Aug. 30, 2015USD ($)	Dec. 31, 2014USD ($)
Debt Instrument [Line Items]
Maximum borrowing capacity		$ 6,500,000	€ 5,800,000		$ 7,000,000
Amount outstanding under lines of credit		0
Debt issuance costs incurred		$ 1,723,000
2010 Credit Facility [Member]
Debt Instrument [Line Items]
Amount outstanding under lines of credit				$ 0
Revolving credit facility expiration date		Aug. 30, 2015
New Credit Agreement [Member] | Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Debt instrument term (in years)		5 years
Maximum borrowing capacity	$ 125,000,000
Amount outstanding under lines of credit		$ 0
Maximum borrowing capacity available for issuance of letters of credit	50,000,000
Maximum additional borrowing capacity	$ 50,000,000
Line of credit, leverage ratio	3
Line of credit, interest coverage ratio	300.00%
Debt issuance costs incurred	$ 1,700,000
New Credit Agreement [Member] | Revolving Credit Facility [Member] | Maximum [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity available for working capital and other general corporate purposes	$ 50,000,000
Line of credit facility, unused commitment fee percentage	0.40%
New Credit Agreement [Member] | Revolving Credit Facility [Member] | Maximum [Member] | LIBOR [Member]
Debt Instrument [Line Items]
Margin on variable rate	2.50%
New Credit Agreement [Member] | Revolving Credit Facility [Member] | Maximum [Member] | Base Rate [Member]
Debt Instrument [Line Items]
Margin on variable rate	1.50%
New Credit Agreement [Member] | Revolving Credit Facility [Member] | Minimum [Member]
Debt Instrument [Line Items]
Line of credit facility, unused commitment fee percentage	0.25%
New Credit Agreement [Member] | Revolving Credit Facility [Member] | Minimum [Member] | LIBOR [Member]
Debt Instrument [Line Items]
Margin on variable rate	1.75%
New Credit Agreement [Member] | Revolving Credit Facility [Member] | Minimum [Member] | Base Rate [Member]
Debt Instrument [Line Items]
Margin on variable rate	0.75%

Derivative Instruments - Schedu

Derivative Instruments - Schedule of Fair Values of Derivative Instruments (Detail) - Other long-term Assets [Member] - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Cross-Currency Swap [Member]
Derivatives Fair Value [Line Items]
Fair value: favorable (unfavorable)	$ 4,633	$ 2,504
Warrants [Member]
Derivatives Fair Value [Line Items]
Fair value: favorable (unfavorable)	$ 311	$ 321

Derivative Instruments - Sche28

Derivative Instruments - Schedule of Gain (Loss) Recognized in Other Comprehensive Income (Loss) (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Cross-Currency Swap [Member]
Derivative [Line Items]
Unrealized gain (loss) on derivative instruments recorded in other comprehensive income (loss), net of taxes	$ (706)	$ 112	$ 230	$ 184

Fair Value Measurements - Sched

Fair Value Measurements - Schedule of Financial Assets and Liabilities Recorded at Fair Value on Recurring Basis (Detail) - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Fair Value, Inputs, Level 3 [Member] | Debt Securities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 15,694
Fair Value, Measurements, Recurring [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	24,829	$ 8,074
Deferred compensation plan, Liabilities	(1,554)	(1,886)
Liabilities fair value, Total	(1,554)	(1,886)
Fair Value, Measurements, Recurring [Member] | Collective Trust Funds [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	1,622	1,696
Fair Value, Measurements, Recurring [Member] | Treasury Securities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	518	586
Fair Value, Measurements, Recurring [Member] | Certificates of Deposit [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	594	1,510
Fair Value, Measurements, Recurring [Member] | Derivative Securities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	4,944	2,825
Fair Value, Measurements, Recurring [Member] | Equity Securities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	1,457	1,457
Fair Value, Measurements, Recurring [Member] | Debt Securities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	15,694
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	1,112	2,096
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Treasury Securities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	518	586
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Certificates of Deposit [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	594	1,510
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	8,023	5,978
Deferred compensation plan, Liabilities	(1,554)	(1,886)
Liabilities fair value, Total	(1,554)	(1,886)
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Collective Trust Funds [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	1,622	1,696
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Derivative Securities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	4,944	2,825
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Equity Securities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	1,457	$ 1,457
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	15,694
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member] | Debt Securities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 15,694

Fair Value Measurements - Addit

Fair Value Measurements - Additional Information (Detail) - eNeura Note [Member] - eNeura Inc [Member] - USD ($) $ in Millions	Mar. 04, 2015	Sep. 30, 2015
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Non-refundable fees paid	$ 0.3
Accrued interest on promissory note	8.00%
Maturity description of Promissory note		The eNeura Note will mature on the earlier of (i) March 4, 2019, or (ii) exercise of the Option.
Debt Instrument, Maturity Date		Mar. 4, 2019
Convertible Debt Securities
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Principal amount of promissory note	$ 15

Fair Value Measurements - Sch31

Fair Value Measurements - Schedule of Reconciliation of Debt Securities (Detail) - Debt Securities [Member] - Fair Value, Inputs, Level 3 [Member] $ in Thousands	9 Months Ended
	Sep. 30, 2015USD ($)
Fair Value Assets Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Additions to debt securities	$ 15,000
Accrued interest income	694
Ending balance	$ 15,694

Accumulated Other Comprehensi32

Accumulated Other Comprehensive Loss - Components of Changes in Accumulated Other Comprehensive Loss (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance			$ (382)
Unrealized gain on derivative instruments, net of tax	$ (706)	$ 112	230	$ 184
Foreign currency translation adjustment	(365)	$ (3,302)	(3,666)	$ (2,728)
Ending Balance	(3,818)		(3,818)
Foreign Currency Translation Adjustments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance			(482)
Foreign currency translation adjustment			(3,666)
Ending Balance	(4,148)		(4,148)
Change in Fair Value [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance			100
Unrealized gain on derivative instruments, net of tax			230
Ending Balance	330		330
Accumulated Other Comprehensive Loss [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance			(382)
Unrealized gain on derivative instruments, net of tax			230
Foreign currency translation adjustment			(3,666)
Ending Balance	$ (3,818)		$ (3,818)

Accumulated Other Comprehensi33

Accumulated Other Comprehensive Loss - Components of Changes in Accumulated Other Comprehensive Loss (Parenthetical) (Detail)	9 Months Ended
	Sep. 30, 2015USD ($)
Foreign Currency Translation Adjustments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Deferred taxes recognized on related foreign currency translation adjustment	$ 0
Change in Fair Value [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Unrealized gain on derivative instruments, tax	130,000
Accumulated Other Comprehensive Loss [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Unrealized gain on derivative instruments, tax	130,000
Deferred taxes recognized on related foreign currency translation adjustment	$ 0

Earnings Per Share - Schedule o

Earnings Per Share - Schedule of Reconciliation of Weighted Average Shares Used in Calculation of Basic and Diluted Net (Loss) Income Per Share (Detail) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Earnings Per Share [Abstract]
Weighted average common shares-basic	18,855,533	18,577,540	18,785,696	18,408,238
Effect of dilutive securities:
Unexercised stock options net of treasury share repurchase		195,846		156,284
Weighted average common shares-diluted	18,855,533	18,773,386	18,785,696	18,564,522

Earnings Per Share - Additional

Earnings Per Share - Additional Information (Detail) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Performance-Based Restricted Stock Awards and Options to Purchase Common Stock [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Outstanding awards and options not included in diluted earnings per share	998,992	1,023,038	942,366	1,055,422
Common Stock Equivalents [Member] | Performance-based restricted stock [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Outstanding awards and options not included in diluted earnings per share	204,432		211,397

Share-based Compensation - Addi

Share-based Compensation - Additional Information (Detail) - USD ($)	Sep. 30, 2015	Aug. 05, 2015	Jun. 30, 2015	Jun. 30, 2014	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense recognized					$ 1,900,000	$ 1,700,000	$ 5,500,000	$ 4,100,000
Shares issued under stock purchase plan					43,326	69,572	271,166	501,862
Performance Based [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Non-vested shares		41,910	68,750	99,600
Restricted Stock [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense recognized	$ 0

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014	Dec. 31, 2014
Income Tax Disclosure [Abstract]
Income tax expense	$ 3,066	$ 4,763	$ 5,808	$ 9,251
Income tax effective rate	134.60%	99.40%	427.00%	87.30%
Income tax effective rate excluding the impact of discrete charges	63.30%	74.70%	279.20%	68.40%
Gross unrecognized tax benefit	$ 15,500		$ 15,500		$ 15,600
Accrued interest and penalties related to unrecognized tax benefits	$ 500		$ 500		$ 500

Business Segment Information -

Business Segment Information - Additional Information (Detail)	9 Months Ended
	Sep. 30, 2015Segment
Segment Reporting [Abstract]
Number of strategic business units	4

Business Segment Information 39

Business Segment Information - Schedule of Net Sales by SBU Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Segment Reporting Information [Line Items]
Net Sales	$ 101,151	$ 100,994	$ 291,867	$ 301,993
Reported Increase (Decrease) (as percent)	0.20%		(3.40%)
Constant Currency Increase (Decrease) (as percent)	4.10%		0.60%
BioStim [Member]
Segment Reporting Information [Line Items]
Net Sales	$ 41,559	38,285	$ 119,962	114,937
Reported Increase (Decrease) (as percent)	8.60%		4.40%
Constant Currency Increase (Decrease) (as percent)	8.60%		4.40%
Biologics [Member]
Segment Reporting Information [Line Items]
Net Sales	$ 14,639	13,856	$ 43,874	40,718
Reported Increase (Decrease) (as percent)	5.70%		7.80%
Constant Currency Increase (Decrease) (as percent)	5.70%		7.80%
Extremity Fixation [Member]
Segment Reporting Information [Line Items]
Net Sales	$ 24,694	27,636	$ 72,103	82,005
Reported Increase (Decrease) (as percent)	(10.60%)		(12.10%)
Constant Currency Increase (Decrease) (as percent)	3.40%		2.10%
Spine Fixation [Member]
Segment Reporting Information [Line Items]
Net Sales	$ 20,259	$ 21,217	$ 55,928	$ 64,333
Reported Increase (Decrease) (as percent)	(4.50%)		(13.10%)
Constant Currency Increase (Decrease) (as percent)	(3.90%)		(12.60%)

Business Segment Information 40

Business Segment Information - Summary of Net Margin by SBU Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Segment Reporting Information [Line Items]
Total net margin	$ 31,157	$ 34,728	$ 93,393	$ 100,356
General and administrative	19,348	19,322	63,423	55,396
Research and development	6,523	6,572	18,819	18,818
Restatements and related costs	1,147	2,326	9,276	12,959
Operating income	4,139	6,508	1,875	13,183
Operating Segments [Member] | BioStim [Member]
Segment Reporting Information [Line Items]
Total net margin	16,834	16,442	47,634	49,168
Operating Segments [Member] | Biologics [Member]
Segment Reporting Information [Line Items]
Total net margin	6,296	6,504	19,525	19,500
Operating Segments [Member] | Extremity Fixation [Member]
Segment Reporting Information [Line Items]
Total net margin	6,442	8,361	22,607	21,952
Operating Segments [Member] | Spine Fixation [Member]
Segment Reporting Information [Line Items]
Total net margin	1,938	3,958	4,582	11,147
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Total net margin	(353)	(537)	(955)	(1,411)
Material Reconciling Items [Member]
Segment Reporting Information [Line Items]
General and administrative	19,348	19,322	63,423	55,396
Research and development	6,523	6,572	18,819	18,818
Restatements and related costs	$ 1,147	$ 2,326	$ 9,276	$ 12,959

Contingencies - Additional Info

Contingencies - Additional Information (Detail) - USD ($) $ in Millions	9 Months Ended	12 Months Ended
	Sep. 30, 2015	Dec. 31, 2014
Commitments And Contingencies Disclosure [Abstract]
Judgments and settlement losses	$ (0.3)	$ (3.8)
Amount paid to settlement of claims	1.3
Discontinued operations for compensatory damages and exemplary damages	$ 5.7