Orthofix Medical (OFIX) 10-K 26 Feb 18 2017 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2017	Feb. 23, 2018	Jun. 30, 2017
Document And Entity Information [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2017
Document Fiscal Year Focus	2,017
Document Fiscal Period Focus	FY
Trading Symbol	OFIX
Entity Registrant Name	ORTHOFIX INTERNATIONAL N V
Entity Central Index Key	884,624
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	Yes
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Filer Category	Large Accelerated Filer
Entity Common Stock, Shares Outstanding		18,405,344
Entity Public Float			$ 842.2

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Current assets
Cash and cash equivalents	$ 81,157	$ 39,572
Restricted cash		14,369
Trade accounts receivable, less allowances of $8,405 and $8,396 at December 31, 2017 and 2016, respectively	63,437	57,848
Inventories	81,330	63,346
Prepaid expenses and other current assets	25,877	19,238
Total current assets	251,801	194,373
Property, plant and equipment, net	45,139	48,916
Patents and other intangible assets, net	10,461	7,461
Goodwill	53,565	53,565
Deferred income taxes	23,315	47,325
Other long-term assets	21,073	20,463
Total assets	405,354	372,103
Current liabilities
Trade accounts payable	18,111	14,353
Other current liabilities	61,295	69,088
Total current liabilities	79,406	83,441
Other long-term liabilities	29,340	25,185
Total liabilities	108,746	108,626
Contingencies (Note 11)
Shareholders’ equity
Common shares $0.10 par value; 50,000,000 shares authorized; 18,278,833 and 17,828,155 issued and outstanding as of December 31, 2017 and 2016, respectively	1,828	1,783
Additional paid-in capital	220,591	204,095
Retained earnings	70,402	64,179
Accumulated other comprehensive income (loss)	3,787	(6,580)
Total shareholders’ equity	296,608	263,477
Total liabilities and shareholders’ equity	$ 405,354	$ 372,103

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Statement Of Financial Position [Abstract]
Trade accounts receivable, allowance for doubtful accounts	$ 8,405	$ 8,396
Common shares, par value	$ 0.10	$ 0.10
Common shares, authorized	50,000,000	50,000,000
Common shares, issued	18,278,833	17,828,155
Common shares, outstanding	18,278,833	17,828,155

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Income Statement [Abstract]
Net sales	$ 433,823	$ 409,788	$ 396,489
Cost of sales	93,037	87,853	86,525
Gross profit	340,786	321,935	309,964
Sales and marketing	198,370	181,287	178,080
General and administrative	74,388	74,404	87,157
Research and development	29,700	28,803	26,389
SEC / FCPA matters and related costs	(2,483)	2,005	9,083
Charges related to U.S. Government resolutions (Note 11)		14,369
Operating income	40,811	21,067	9,255
Interest income (expense), net	(416)	763	(489)
Other expense, net	(4,004)	(2,806)	(259)
Income before income taxes	36,391	19,024	8,507
Income tax expense	(29,100)	(15,527)	(10,849)
Net income (loss) from continuing operations	7,291	3,497	(2,342)
Discontinued operations (Note 11)
Loss from discontinued operations	(1,759)	(638)	(1,827)
Income tax benefit	691	197	1,360
Net loss from discontinued operations	(1,068)	(441)	(467)
Net income (loss)	$ 6,223	$ 3,056	$ (2,809)
Net income (loss) per common share—basic
Net income (loss) from continuing operations	$ 0.40	$ 0.19	$ (0.12)
Net loss from discontinued operations	(0.06)	(0.02)	(0.03)
Net income (loss) per common share—basic	0.34	0.17	(0.15)
Net income (loss) per common share—diluted
Net income (loss) from continuing operations	0.39	0.19	(0.12)
Net loss from discontinued operations	(0.05)	(0.02)	(0.03)
Net income (loss) per common share—diluted	$ 0.34	$ 0.17	$ (0.15)
Weighted average number of common shares:
Basic	18,117,405	18,144,019	18,795,194
Diluted	18,498,745	18,463,161	18,795,194
Other comprehensive income (loss), before tax
Unrealized gain (loss) on derivative instrument		$ (360)	$ 202
Unrealized gain (loss) on debt securities	$ 3,830	(1,744)	(3,348)
Reclassification adjustment for loss on debt securities in net income	5,585	2,727
Currency translation adjustment	4,552	(726)	(3,907)
Other comprehensive income (loss) before tax	13,967	(103)	(7,053)
Income tax benefit (expense) related to items of other comprehensive income (loss)	(3,600)	(245)	1,203
Other comprehensive income (loss), net of tax	10,367	(348)	(5,850)
Comprehensive income (loss)	$ 16,590	$ 2,708	$ (8,659)

Consolidated Statements of Chan

Consolidated Statements of Changes in Shareholders' Equity - USD ($) $ in Thousands	Total	Common Shares [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	Accumulated Other Comprehensive Income (Loss) [Member]
Beginning Balance at Dec. 31, 2014	$ 299,627	$ 1,861	$ 232,788	$ 65,360	$ (382)
Balance, Shares at Dec. 31, 2014		18,611,495
Net income (loss)	(2,809)			(2,809)
Other comprehensive income (loss), net of tax	(5,850)				(5,850)
Share-based compensation	7,214		7,214
Common shares issued	3,704	$ 34	3,670
Common shares issued, Shares		342,192
Retirement of repurchased common stock	(11,575)	$ (29)	(11,546)
Retirement of repurchased common stock, Shares		(293,991)
Ending Balance at Dec. 31, 2015	290,311	$ 1,866	232,126	62,551	(6,232)
Balance, Shares at Dec. 31, 2015		18,659,696
Cumulative effect adjustment from adoption of ASU 2016-09	604		2,032	(1,428)
Net income (loss)	3,056			3,056
Other comprehensive income (loss), net of tax	(348)				(348)
Share-based compensation	15,966		15,966
Common shares issued	17,313	$ 71	17,242
Common shares issued, Shares		713,140
Retirement of repurchased common stock	$ (63,425)	$ (154)	(63,271)
Retirement of repurchased common stock, Shares	(1,544,681)	(1,544,681)
Ending Balance at Dec. 31, 2016	$ 263,477	$ 1,783	204,095	64,179	(6,580)
Balance, Shares at Dec. 31, 2016	17,828,155	17,828,155
Net income (loss)	$ 6,223			6,223
Other comprehensive income (loss), net of tax	10,367				10,367
Share-based compensation	12,557		12,557
Common shares issued	3,984	$ 45	3,939
Common shares issued, Shares		450,678
Ending Balance at Dec. 31, 2017	$ 296,608	$ 1,828	$ 220,591	$ 70,402	$ 3,787
Balance, Shares at Dec. 31, 2017	18,278,833	18,278,833

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Cash flows from operating activities
Net income (loss)	$ 6,223	$ 3,056	$ (2,809)
Adjustments to reconcile net income (loss) to net cash from operating activities
Depreciation and amortization	20,124	20,841	20,923
Amortization of debt costs and other assets	1,712	1,569	1,752
Provision for doubtful accounts	1,639	1,117	3,431
Deferred income taxes	21,286	10,460	(1,156)
Share-based compensation	12,557	15,966	7,214
Gain on sale of assets			(3,099)
Other-than-temporary impairment on debt securities	5,585	2,727
Other	1,398	1,061	2,854
Changes in operating assets and liabilities
Restricted cash	14,369	(14,369)
Trade accounts receivable	(6,562)	392	(1,547)
Inventories	(15,645)	(5,284)	3,136
Prepaid expenses and other current assets	(6,352)	701	8,697
Other long-term assets	1,490	(3,333)	(1,321)
Trade accounts payable	2,324	(1,771)	3,011
Other current liabilities	(11,412)	6,537	1,515
Other long-term liabilities	4,605	5,037	1,009
Net cash from operating activities	53,341	44,707	43,610
Cash flows from investing activities
Capital expenditures for property, plant and equipment	(14,665)	(16,432)	(27,197)
Capital expenditures for intangible assets	(2,283)	(1,902)	(702)
Purchase of debt securities			(15,250)
Proceeds from sale of assets			4,800
Net cash from investing activities	(16,474)	(21,947)	(38,349)
Other investing activities	474	(3,613)
Cash flows from financing activities
Proceeds from issuance of common shares	7,783	19,720	5,254
Payments related to withholdings for share-based compensation	(3,800)	(2,407)	(1,550)
Payment of debt issuance costs	(445)		(1,825)
Changes in restricted cash			34,424
Repurchase and retirement of common shares		(63,425)	(11,575)
Net cash from financing activities	3,538	(46,112)	24,728
Effect of exchange rate changes on cash	1,180	(739)	(3,141)
Net change in cash and cash equivalents	41,585	(24,091)	26,848
Cash and cash equivalents at the beginning of the year	39,572	63,663	36,815
Cash and cash equivalents at the end of the year	81,157	39,572	63,663
Cash paid during the year for:
Interest	811	672	852
Income taxes	$ 3,265	$ 4,423	$ 3,160

Business and basis of consolida

Business and basis of consolidation	12 Months Ended
	Dec. 31, 2017
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Business and basis of consolidation	Business and basis of consolidation Orthofix International N.V. and its subsidiaries (the “Company”) is a global medical device company focused on musculoskeletal healing products and value-added services. Headquartered in Lewisville, Texas, the Company has four strategic business units (“SBUs”): BioStim, Extremity Fixation, Spine Fixation, and Biologics. Orthofix products are widely distributed via the Company's sales representatives and distributors. The consolidated financial statements include the financial statements of the Company and its wholly owned subsidiaries. All intercompany accounts and transactions are eliminated in consolidation.

Significant accounting policies

Significant accounting policies	12 Months Ended
	Dec. 31, 2017
Accounting Policies [Abstract]
Significant accounting policies	1. Significant accounting policies The preparation of financial statements in conformity with United States generally accepted accounting principles (“U.S. GAAP”) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. On an ongoing basis, we evaluate these estimates, including those related to contractual allowances, doubtful accounts, inventories, goodwill, income taxes, fair value measurements, litigation and contingent liabilities, and share-based compensation. We base our estimates on historical experience, future expectations and other relevant assumptions that are believed to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of assets and liabilities that are not readily apparent from other sources. Actual results could differ from those estimates. Information on our accounting policies and methods used in the preparation of our consolidated financial statements are included, where applicable, in their respective footnotes that follow. Significant Accounting Policy Footnote Reference Inventories 2 Property, plant and equipment 3 Patents and other intangible assets 4 Goodwill 5 Long-term debt 8 Fair value measurements 9 Contingencies 11 Revenue recognition and accounts receivable 13 Share-based compensation 15 Defined contribution plans and deferred compensation 16 Income taxes 17 The following is a discussion of accounting policies and methods used in our consolidated financial statements that are not presented within other footnotes. Market risk In the ordinary course of business, the Company is exposed to the impact of changes in interest rates and foreign currency fluctuations. The Company’s objective is to limit the impact of such movements on earnings and cash flows. In order to achieve this objective, the Company seeks to balance its non-U.S. dollar denominated income and expenditures. During 2016 and 2015, the Company made use of a cross-currency swap agreement to manage cash flow exposure generated from foreign currency fluctuations. This cross-currency swap matured and was settled on December 30, 2016. The financial statements for operations outside the United States are generally maintained in their local currency. All foreign currency denominated balance sheet accounts, except shareholders’ equity, are translated to U.S. dollars at year end exchange rates and revenue and expense items are translated at weighted average rates of exchange prevailing during the year. Gains and losses resulting from the translation of foreign currency are recorded in the accumulated other comprehensive income (loss) component of shareholders’ equity. Transactional foreign currency gains and losses, including those generated from intercompany operations, are included in other expense, net and were a gain of $1.9 million, and losses of less than $0.1 million and $3.5 million for the years ended December 31, 2017, 2016 and 2015, respectively. Financial instruments and concentration of credit risk Financial instruments that could subject the Company to a concentration of credit risk consist primarily of cash and cash equivalents and accounts receivable. Generally, the cash is held at large financial institutions and cash equivalents consist of highly liquid money market funds. The Company performs ongoing credit evaluations of customers, generally does not require collateral, and maintains a reserve for potential credit losses. The Company believes that a concentration of credit risk related to the accounts receivable is limited because customers are geographically dispersed and end users are diversified across several industries. Net sales to our customers based in Europe were approximately $57 million in 2017, which results in a substantial portion of our trade accounts receivable balance as of December 31, 2017. It is at least reasonably possible that changes in global economic conditions and/or local operating and economic conditions in the regions these distributors operate, or other factors, could affect the future realization of these accounts receivable balances. Cash, cash equivalents and restricted cash The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. In 2016, restricted cash consisted of amounts held in escrow as of December 31, 2016, to fund the payment of settlement amounts for charges related to U.S. Government resolutions, as further discussed in Note 11. Derivative Instruments The Company manages its exposure to fluctuating cash flows resulting from changes in interest rates and foreign exchange rates within the consolidated financial statements according to its hedging policy. The policy requires the Company to formally document the relationship between the hedging instrument and hedged item, as well as its risk-management objective and strategy for undertaking the hedge transaction. For instruments designated as a cash flow hedge, the Company formally assesses (both at the hedge’s inception and on an ongoing basis) whether the derivative used in the hedging transaction has been effective in offsetting changes in the cash flows of the hedged item and whether such derivative may be expected to remain effective in future periods. If it is determined that a derivative is not (or has ceased to be) effective as a hedge, the Company discontinues the related hedge accounting prospectively. The Company records all derivatives as either assets or liabilities on the balance sheet at their respective fair values. For a cash flow hedge, the effective portion of the derivative’s change in fair value (i.e., gains or losses) is initially reported as a component of other comprehensive income, net of related taxes, and subsequently reclassified into net earnings in the period the hedged transaction affects earnings. On September 30, 2010, the Company entered into a cross-currency swap agreement to manage its cash flows related to foreign currency exposure for a portion of an intercompany note receivable of a U.S. dollar functional currency subsidiary that was denominated in Euro. Both the cross-currency swap and the related Euro denominated intercompany note matured and were settled on December 30, 2016. Research and development costs Expenditures related to the collaborative arrangement with MTF Biologics (“MTF”) are expensed based on the terms of the related agreement. Expenditures incurred under the collaborative arrangement with MTF totaled $0.9 million in 2017 and $1.3 million in 2016. No expenditures were incurred in 2015. Expenditures for research and development are expensed as incurred. Recently issued income tax accounting guidance In December 2017, the SEC staff issued Staff Accounting Bulletin No. 118 (“SAB 118”) to address the application of U.S. GAAP in situations when a registrant does not have the necessary information available, prepared, or analyzed (including computations) in reasonable detail to complete the accounting for certain income tax effects of the Tax Cuts and Jobs Act (the “Tax Act”). See Note 17 for further discussion. Further, in January 2018, the FASB released guidance on the accounting for tax on the global intangible low taxed income (“GILTI”) provisions of the Tax Act. The GILTI provisions impose a tax on foreign income in excess of deemed return on tangible assets of foreign corporations. The guidance indicated that either accounting for deferred taxes related to GILTI inclusion or to treat any taxes on GILTI inclusion as a period cost are both acceptable methods subject to an accounting policy election. The Company is currently evaluating this policy decision. Recently issued accounting standards Topic Description of Guidance Effective Date Status of Company's Evaluation Revenue Recognition (ASU 2014-09, as amended) Requires entities to recognize revenue in a way that depicts the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled to in exchange for those goods or services. Applied either retrospectively or as a cumulative effect adjustment as of the adoption date. January 1, 2018 In 2015, the Company established a cross-functional implementation team to analyze the impact of the standard on the Company's contract portfolio by reviewing the Company's current accounting policies and practices to identify potential differences that would result from applying the requirements of the new standard to the Company's contracts. In addition, the implementation team identified and implemented appropriate changes to the Company's business processes, systems, and controls to support recognition and disclosure under the new standard. The implementation team has reported the findings and progress of the project to management and to the Audit Committee on a frequent basis over the last two years. In the fourth quarter of 2017, the Company finalized its assessment of the new standard, including the review of contracts within each SBU and the drafting of new policies and procedures. Adoption of this ASU has a material impact related to the timing of revenue recognition, primarily for Extremity Fixation and Spine Fixation product sales to stocking distributors, which are currently accounted for using the sell-through method. Subsequent to adoption, revenue associated with these sales will be recorded at the time of the sale instead of deferring recognition until cash is received. The Company will adopt the standard using the modified retrospective transition method and will record a cumulative effect adjustment as of January 1, 2018, which will result in a significant increase in accounts receivable and a decrease in inventories, with these changes offset by an adjustment to the Company's opening retained earnings of approximately $5 million. Prior periods will not be retrospectively adjusted. Adopting this guidance will also result in material changes to the Company's disclosures for revenue recognition and contracts with customers. Financial Instruments (ASU 2016-01) Requires entities to measure equity investments, except in limited circumstances, at fair value and recognize any changes in fair value in net income. Applied prospectively. January 1, 2018 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Leases (ASU 2016-02) Requires a lessee to recognize lease assets and lease liabilities for leases classified as operating leases. Applied using a modified retrospective approach. January 1, 2019 The Company is currently in process of establishing a cross-functional implementation team to analyze the impact of the standard on the Company's lease portfolio and to evaluate the impact this ASU may have on its consolidated financial statements; however, the Company expects this guidance will materially impact the Company's balance sheet, resulting in current operating lease obligations being reflected on the consolidated balance sheet. Income Taxes (ASU 2016-16) Reduces complexity by requiring the recognition of current and deferred income taxes for an intra-entity asset transfer, other than inventory, when the transfer occurs. Applied using a modified retrospective approach. January 1, 2018 During the third and fourth quarters of 2017, the Company executed two intra-entity asset transfers that resulted in prepaid income taxes of $8.6 million. The Company will adopt the new standard using a modified retrospective approach as of January 1, 2018, which will result in a reduction of prepaid income taxes and an increase in deferred tax assets with these change offset by an adjustment to the Company's opening retained earnings of approximately $2.1 million. However, the Company does not expect this guidance to have a material impact relating to its consolidated statements of operations and comprehensive income (loss) or to its consolidated statements of cash flows. Statement of Cash Flows (ASU 2016-18) Reduces diversity in classification and presentation of restricted cash, including transfers between cash and restricted cash, on the statement of cash flows. Applied retrospectively. January 1, 2018 The Company believes this ASU will materially impact its consolidated statement of cash flows. Adoption of this ASU is expected to result in an increase in net cash from operating activities of $14.4 million for the year ended December 31, 2016 and would have resulted in a decrease in net cash from operating activities of $14.4 million for the year ended December 31, 2017, if this ASU had been early adopted. Goodwill (ASU 2017-04) Eliminates Step 2 of the current goodwill impairment test, which requires a hypothetical purchase price allocation to measure goodwill impairment. A goodwill impairment loss will instead be measured at the amount by which a reporting unit's carrying value exceeds its fair value, not to exceed the recorded amount of goodwill. January 1, 2020 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. However, the Company does not expect this ASU to have a significant impact on its financial statements or disclosures. Comprehensive Income (ASU 2018-02) Allows entities to reclassify from accumulated other comprehensive income to retained earnings stranded tax effects resulting from the Tax Act. January 1, 2019 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements.

Inventories

Inventories	12 Months Ended
	Dec. 31, 2017
Inventory Disclosure [Abstract]
Inventories	2. Inventories Inventories are valued at the lower of cost or estimated net realizable value, after provision for excess, obsolete or impaired items, which is reviewed and updated on a periodic basis by management. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at our manufacturing facility in Italy, cost is determined on a weighted-average basis, which approximates the first-in, first-out (“FIFO”) method. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at our manufacturing facility in Texas, standard costs, which approximates actual cost on the FIFO method, is used to value inventory. Standard costs are reviewed annually by management, or more often in the event circumstances indicate a change in cost has occurred. Work-in-process, finished products, field inventory and consignment inventory include material, labor and production overhead costs. Field inventory represents immediately saleable finished products inventory that is in the possession of the Company’s independent sales representatives. Consignment inventory 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 yet been met. Once all revenue recognition criteria have been met, the revenue and associated cost of sales are recognized. December 31, (U.S. Dollars, in thousands) 2017 2016 Raw materials $ 6,067 $ 7,978 Work-in-process 12,487 9,505 Finished products 11,244 15,985 Field inventory 40,262 22,021 Consignment inventory 8,935 4,428 Deferred cost of sales 2,335 3,429 Inventories $ 81,330 $ 63,346 The Company adjusts the value of its inventory to the extent management determines that the cost cannot be recovered due to obsolescence or other factors. In order to make these determinations, management uses estimates of future demand and sales prices for each product to determine the appropriate inventory reserves and to make corresponding adjustments to the carrying value of these inventories to reflect the lower of cost or market value.

Property, plant and equipment

Property, plant and equipment	12 Months Ended
	Dec. 31, 2017
Property Plant And Equipment [Abstract]
Property, plant and equipment	3. Property, plant and equipment Property, plant and equipment is stated at cost less accumulated depreciation. Costs include all expenditures necessary to place the asset in service, including freight and sales and use taxes. Property, plant and equipment includes instrumentation held by customers, which is generally used to facilitate the implantation of the Company’s products. Years Buildings 25 to 33 Plant and equipment 1 to 10 Instrumentation 3 to 4 Computer software 3 to 7 Furniture and fixtures 4 to 8 The Company evaluates the useful lives of these assets on an annual basis. Depreciation is computed on a straight-line basis over the useful lives of the assets. Depreciation of leasehold improvements is computed over the shorter of the lease term or the useful life of the asset. Total depreciation expense was $18.3 million, $19.0 million and $19.2 million for the years ended December 31, 2017, 2016 and 2015, respectively. Expenditures for maintenance and repairs and minor renewals and improvements, which do not extend the lives of the respective assets, are expensed as incurred. All other expenditures for renewals and improvements are capitalized. The assets and related accumulated depreciation are adjusted for property retirements and disposals, with the resulting gain or loss included in earnings. Fully depreciated assets remain in the accounts until retired from service. December 31, (U.S. Dollars, in thousands) 2017 2016 Cost Buildings $ 3,725 $ 3,225 Plant and equipment 47,588 43,745 Instrumentation 75,818 71,962 Computer software 48,604 44,720 Furniture and fixtures 7,605 8,308 Construction in progress 769 1,907 184,109 173,867 Accumulated depreciation (138,970 ) (124,951 ) Property, plant and equipment, net $ 45,139 $ 48,916 The Company capitalizes system development costs related to its internal use software during the application development stage. Costs related to preliminary project activities and post implementation activities are expensed as incurred. Internal-use software is amortized on a straight-line basis over its estimated useful life, generally three to seven years. Long-lived assets are evaluated for impairment whenever events or changes in circumstances have occurred that would indicate impairment. For purposes of the evaluation, the Company groups its long-lived assets with other assets and liabilities at the lowest level of identifiable cash flows if the asset does not generate cash flows independent of other assets and liabilities. If the carrying value of the asset (asset group) exceeds the undiscounted cash flows expected to result from the use and eventual disposition of the asset (asset group), the Company will write the carrying value down to the fair value in the period identified. The Company generally determines fair value of long-lived assets as the present value of estimated future cash flows. In determining the estimated future cash flows associated with the assets, the Company uses estimates and assumptions about future revenue contributions, cost structures and remaining useful lives of the asset (asset group). The use of alternative assumptions, including estimated cash flows, discount rates, and alternative estimated remaining useful lives could result in different calculations of impairment.

Patents and other intangible as

Patents and other intangible assets	12 Months Ended
	Dec. 31, 2017
Goodwill And Intangible Assets Disclosure [Abstract]
Patents and other intangible assets	4. Patents and other intangible assets Patents and other intangible assets are recorded at cost, or when acquired as a part of a business combination at estimated fair value. These assets are amortized on a straight-line basis over the useful lives of the assets. The Company’s weighted average amortization period for developed technologies is 11 years. December 31, (U.S. Dollars, in thousands) 2017 2016 Cost Patents $ 38,621 $ 38,348 License and other 10,276 7,611 Trademarks—finite lived 533 319 49,430 46,278 Accumulated amortization Patents (34,151 ) (34,717 ) License and other (4,625 ) (3,962 ) Trademarks—finite lived (193 ) (138 ) (38,969 ) (38,817 ) Patents and other intangible assets, net $ 10,461 $ 7,461 Amortization expense for intangible assets was $1.8 million, $1.8 million and $1.7 million for the years ended December 31, 2017, 2016 and 2015, respectively. Future amortization expense for intangible assets is estimated as follows: (U.S. Dollars, in thousands) Amortization 2018 $ 2,352 2019 1,909 2020 1,366 2021 1,321 2022 1,314 Thereafter 2,199 Total $ 10,461

Goodwill

Goodwill	12 Months Ended
	Dec. 31, 2017
Goodwill And Intangible Assets Disclosure [Abstract]
Goodwill	5. Goodwill The Company tests goodwill at least annually for impairment. The Company tests more frequently if indicators are present or changes in circumstances suggest that impairment may exist. These indicators include, among others, declines in sales, earnings or cash flows, or the development of a material adverse change in the business climate. The Company assesses goodwill for impairment at the reporting unit level, which is defined as an operating segment or one level below an operating segment. At the beginning of the fourth quarter of 2017, the Company performed a qualitative assessments for its annual goodwill impairment analysis, which did not result in an impairment charge for either the BioStim or Biologics reporting units, the only reporting units with goodwill. This qualitative analysis considers all relevant factors specific to the reporting units, including macroeconomic conditions, industry and market considerations, overall financial performance, and relevant entity-specific events. In 2016 the Company performed a quantitative impairment analysis that did not result in an impairment charge and in 2015 the Company performed a qualitative assessment, which did not result in any impairment charge. The following table presents the net carrying value of goodwill by reportable segment: December 31, (U.S. Dollars, in thousands) 2017 2016 BioStim $ 42,678 $ 42,678 Extremity Fixation — — Spine Fixation — — Biologics 10,887 10,887 Goodwill $ 53,565 $ 53,565

Long-term investments

Long-term investments	12 Months Ended
	Dec. 31, 2017
Investments Debt And Equity Securities [Abstract]
Long-term investments	6. Long-term investments Debt securities On March 2015, Company Option Agreement (the “Option Agreement”) with eNeura, Inc. (“eNeura”), privately technology company devices treatment migraines. The Option Agreement provided the Company an exclusive acquire eNeura (the “Option”) during 18-month following grant the Option, which expired in September 2016 without the Company exercising the option. consideration for the Option, (i) Company non-refundable $0.3 million fee eNeura, and the Company loaned eNeura Convertible Promissory Note “eNeura Note”) that was issued Company. The principal of the eNeura Note $15.0 million interest accrues at The eNeura Note will mature March 4, The investment is recorded in other long-term assets as an available for sale debt security at fair value and interest is recorded in interest income; however, the Company discontinued recognition of interest on the eNeura Note in the first quarter of 2017. As of Mar ch 31, 2017, the fair value of the debt security was determined to be $9.0 million, which represented a $3.2 million decrease from its fair value as of December 31, 2016. The Company recorded this decrease in the fair value in other comprehensive income (loss) as an unrealized loss on debt securities. Further, based upon the Company’s best estimate of the amount it expected to recover at the time, the Company recorded an other-than-temporary impairment of $5.6 million during the first quarter of 2017. This other-than-temporary impairment was reclassified from accumulated other comprehensive loss and is included within other expense. See Note 9 for further discussion. As of December 31, 2017, the fair value of the debt security is $16.1 million, which represents a net increase of $7.1 million in relation to the balance as of March 31, 2017, and compares to an amortized cost basis of $9.0 million. The Company recorded this increase in the fair value in other comprehensive income as an unrealized gain on debt securities. Equity investment and warrants As of December 31, 2017, the Company holds common stock of Bone Biologics, Inc. (“Bone Biologics”) totaling $2.5 million and warrants to purchase 458 thousand shares at a weighted average exercise price of $1.18 per share. These instruments are recorded within other long-term assets. The fair value of these instruments has not been estimated, and is instead recorded at cost, as the fair value is not readily determinable. In addition, there have been no events or changes in circumstances that would indicate a significant adverse effect on the fair value of the instruments. Under the terms of the warrant purchase agreements, the warrants to purchase common stock in Bone Biologics are exercisable over a seven year period, which expire between 2020 and 2021, and are transferable by the holder to other parties.

Other current liabilities

Other current liabilities	12 Months Ended
	Dec. 31, 2017
Payables And Accruals [Abstract]
Other current liabilities	7. Other current liabilities December 31, (U.S. Dollars, in thousands) 2017 2016 Accrued expenses $ 6,984 $ 6,155 Salaries, bonuses, commissions and related taxes payable 24,635 19,636 Accrued distributor commissions 9,192 9,379 Accrued legal and settlement expenses 7,673 23,081 Non-income taxes payable 3,180 7,301 Other payables 9,631 3,536 Other current liabilities $ 61,295 $ 69,088 Extremity Fixation restructuring plan In December 2016, the Company approved and initiated a planned restructuring, which primarily affects the Extremity Fixation SBU, to streamline costs, improve operational performance, and wind down a non-core business. The Extremity Fixation restructuring plan consists of primarily severance charges, professional fees and the write-down of certain assets. The Company expects to incur total pre-tax expense of approximately $3.3 million in connection with this restructuring activity and has incurred cumulative costs to date of $3.3 million, largely within cost of sales and operating expenses. The Company had an accrual of $1.5 million as of December 31, 2016 in other current liabilities related to the planned restructuring. In 2017, the Company incurred costs of $1.3 million and made payments of $2.1 million relating to these activities, resulting in a remaining accrual of $0.7 million as of December 31, 2017. U.S. restructuring plan In September 2017, the Company approved and executed an additional restructuring plan, which primarily affects the entity’s corporate shared services in the U.S. to streamline costs and to improve operational performance. The U.S. restructuring plan consists primarily of severance charges. The Company estimates total pre-tax expense of approximately $1.7 million in connection with this restructuring activity, all of which was incurred in 2017, and recorded within cost of sales and operating expenses. Payments were made in 2017 of $0.6 million relating to these activities; therefore, $1.1 million is accrued within other current liabilities as of December 31, 2017.

Long-term debt

Long-term debt	12 Months Ended
	Dec. 31, 2017
Debt Disclosure [Abstract]
Long-term debt	8. Long-term debt On August 31, 2015, the Company, through its subsidiaries Orthofix Holdings and Victory Medical Limited (“Victory Medical”, and collectively with Orthofix Holdings, the “Borrowers”), entered into a Credit Agreement (the “Credit Agreement”) with JPMorgan, as Administrative Agent, and certain lenders party thereto. The Credit Agreement provides for a five year $125 million secured revolving credit facility (the “Facility”). The Credit Agreement has a maturity date of August 31, 2020. As of December 31, 2017, the Company has no borrowings outstanding under the Credit Agreement. Borrowings under the 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 Credit Agreement further permits up to $25 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 Credit Agreement. The obligations of the Borrowers and each of the Guarantors with respect to the 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 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 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 is in compliance with all required financial covenants as of December 31, 2017. The 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 $1.8 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. As of December 31, 2017 and 2016, debt issuance costs, net of accumulated amortization, were $1.0 million and $1.3 million, respectively. Debt issuance costs amortized or expensed related to the Facility and the Amendment totaled $1.0 million, $0.4 million, and $0.6 million for the years ended December 31, 2017, 2016, and 2015, respectively. On December 8, 2017, the Company amended the Credit Agreement with JPMorgan, the Administrative Agent, and certain lenders party thereto. The primary provision of the Credit Agreement to be amended, among other things, was to add the Company’s subsidiary, Orthofix International B.V., as a Borrower, Guarantor, and a loan party. In addition, two of the Company’s subsidiaries, Orthofix Limited and Orthofix II B.V. were also added as Guarantors and loan parties. The Company has an unused available line of credit of €5.8 million ($7.0 million and $6.1 million) at December 31, 2017 and 2016, respectively, in its Italian line of credit. This unsecure line of credit provides the Company the option to borrow amounts in Italy at rates, which are determined at the time of borrowing.

Fair value measurements

Fair value measurements	12 Months Ended
	Dec. 31, 2017
Fair Value Disclosures [Abstract]
Fair value measurements	9. Fair value measurements Fair value is defined as the price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. Non-financial assets and liabilities of the Company measured at fair value include any long-lived assets or equity method investments that are impaired in a currently reported period. The authoritative guidance also describes three levels of inputs that may be used to measure fair value: Level 1: quoted prices in active markets for identical assets and liabilities Level 2: observable inputs other than quoted prices in active markets for identical assets and liabilities Level 3: unobservable inputs in which there is little or no market data available, which require the reporting entity to develop its own assumptions The Company’s financial instruments include cash equivalents, restricted cash, foreign certificates of deposit, treasury securities, collective trust funds, trade accounts receivable, accounts payable, long-term secured debt, equity securities, available for sale debt securities, common stock warrants, and deferred compensation plan liabilities. The carrying value of restricted cash, trade accounts receivable and accounts payable approximate fair value due to the short-term maturities of these instruments. The Company’s credit facilities carry a floating rate of interest, and therefore, the carrying value is considered to approximate the fair value. The Company’s equity securities and common stock warrants are recorded at cost, as the fair value of these instruments is not readily available. See Note 6 for further discussion. The Company’s collective trust funds, treasury securities, foreign certificates of deposit, debt securities, and deferred compensation plan liabilities are the only financial instruments recorded at fair value on a recurring basis as follows: (U.S. Dollars, in thousands) Balance December 31, 2017 Level 1 Level 2 Level 3 Assets Collective trust funds $ 100 $ — $ 100 $ — Treasury securities 556 556 — — Debt security 16,050 — — 16,050 Total $ 16,706 $ 556 $ 100 $ 16,050 Liabilities Deferred compensation plan $ (1,379 ) $ — $ (1,379 ) $ — Total $ (1,379 ) $ — $ (1,379 ) $ — (U.S. Dollars, in thousands) Balance December 31, 2016 Level 1 Level 2 Level 3 Assets Collective trust funds $ 1,584 $ — $ 1,584 $ — Treasury securities 467 467 — — Certificates of deposit 468 468 — — Debt security 12,220 — — 12,220 Total $ 14,739 $ 935 $ 1,584 $ 12,220 Liabilities Deferred compensation plan $ (1,452 ) $ — $ (1,452 ) $ — Total $ (1,452 ) $ — $ (1,452 ) $ — The fair value of treasury securities and certificates of deposit are determined based on quoted prices in active markets for identical assets, therefore, the Company has categorized these instruments as Level 1 financial instruments. The certificates of deposit were held in foreign currencies and carried a contractual maturity of two years from the date of purchase and matured in 2017. The fair value of the Company’s collective trust funds and deferred compensation plan liabilities are determined based on inputs that are readily available in public markets or can be derived from information available in publicly quoted markets; therefore, the Company has categorized these instruments as Level 2 financial instruments. The fair value of the debt security, including accrued interest, is based upon significant unobservable inputs, including the use of a discounted cash flows model, requiring the Company The Company evaluates any declines in fair value each quarter to determine if impairments are other-than-temporary. Based upon the Company’s best estimate of the amount it expected to recover at the time, the Company recorded an other-than-temporary impairment of $5.6 million in the first quarter of 2017. The Company also recorded an other-than-temporary impairment of $2.7 million in 2016. These other-than-temporary impairments were reclassified from accumulated other comprehensive loss and are included within other expense. 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) 2017 2016 Balance at January 1 $ 12,220 $ 12,658 Accrued interest income — 1,306 Gains or losses recorded for the period Recognized in net income (5,585 ) (2,727 ) Recognized in other comprehensive income 9,415 983 Balance at December 31 $ 16,050 $ 12,220

Commitments

Commitments	12 Months Ended
	Dec. 31, 2017
Commitments And Contingencies Disclosure [Abstract]
Commitments	10. Commitments Leases The Company has entered into operating leases for facilities and equipment. These leases are non-cancellable and typically do not contain renewal options. Certain leases contain rent escalation clauses for which the Company recognizes the expense on a straight-line basis. Rent expense under the Company’s operating leases for the years ended December 31, 2017, 2016 and 2015 was approximately $3.1 million, $3.0 million and $3.0 million, respectively. Future minimum lease payments under operating leases as of December 31, 2017 are as follows: (U.S. Dollars, in thousands) 2018 $ 3,017 2019 2,018 2020 1,240 2021 1,575 2022 1,600 Thereafter 12,156 Total $ 21,606 Inventory purchase commitments The Company had inventory purchase commitments with third-party manufactures for $1.9 million and $1.2 million as of December 31, 2017, and 2016, respectively.

Contingencies

Contingencies	12 Months Ended
	Dec. 31, 2017
Commitments And Contingencies Disclosure [Abstract]
Contingencies	11. Contingencies The Company records 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. The Company evaluates, 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, the Company does 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 the Company discloses a reasonable estimate of the possible loss or range of loss, if such reasonable estimate can be made. If the Company cannot make a reasonable estimate of the possible loss, or range of loss, then that is disclosed. In addition, legal fees and other directly related costs are expensed as incurred. In addition to the matters described in the paragraphs below, 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. The Company believes any losses related to these matters are individually and collectively immaterial as to a possible loss and range of loss. January 2017 SEC Settlements In January 2017, the U.S. Securities and Exchange Commission (the “SEC”) approved the Company’s offers of settlement in connection with the SEC’s investigations of accounting matters leading to the Company’s prior restatement of financial statements and the Company’s review of improper payments with respect to its subsidiary in Brazil. Both investigations were initiated in 2013 and involved matters self-reported to the SEC by the Company. The settlements approved by the SEC resolved these two matters, and included payments totaling $14.4 million by the Company to the SEC of amounts previously accrued and funded into escrow by the Company during 2016. In connection with the Brazil-related settlement, the Company agreed to retain an independent compliance consultant for one year to review and test the Company’s compliance program related to the U.S. Foreign Corrupt Practices Act. The Company’s engagement with its independent compliance consultant began in March 2017. In addition, in the fourth quarter of 2017 the Company received a favorable insurance settlement of approximately $6 million associated with prior costs incurred related to these matters, which the Company has recognized within the in SEC / FCPA matters and related costs line of the consolidated statement of operations and comprehensive income (loss). Discontinued Operations – Matters Related to Breg and Possible Indemnification Obligations On May 24, 2012, the Company sold Breg to an affiliate of Water Street Healthcare Partners II, L.P. (“Water Street”). Under the terms of the agreement, the Company indemnified Water Street and Breg with respect to certain specified matters. At the time of its divestiture by the Company, Breg was engaged in the manufacturing and sales of motorized cold therapy units used to reduce pain and swelling. Several domestic product liability cases were filed, mostly in California state court. In September 2014, the Company entered into a master settlement agreement resolving then pending pre-close cold therapy claims. Currently pending is a post-close cold therapy claim in California state court. As of December 31, 2017, the Company has an accrual of $1.7 million recorded within other current liabilities; however, the actual liability could be higher or lower than the amount accrued. Charges incurred as a result of this indemnification are reflected as discontinued operations in our Consolidated Statements of Operations and Comprehensive Income (Loss).

Shareholder's equity

Shareholder's equity	12 Months Ended
	Dec. 31, 2017
Stockholders Equity Note [Abstract]
Shareholders' equity	12. Shareholders’ equity Dividends The Company has not paid dividends to holders of its common stock in the past. Certain subsidiaries of the Company have restrictions on their ability to pay dividends in certain circumstances pursuant to the Credit Agreement. In the event that the Company decides to pay a dividend to holders of its common stock in the future with dividends received from its subsidiaries, the Company may, based on prevailing rates of taxation, be required to pay additional withholding and income tax on such amounts received from its subsidiaries. Share Repurchase Plan In August 2015, the Company’s Board of Directors authorized a share repurchase plan, authorizing the purchase of up to $75 million of the Company’s common stock through and including September 2017. The Company completed the share repurchase plan in the fourth quarter of 2016. Under the program, common shares repurchased consisted of open market transactions at prevailing market prices in accordance with the guidelines specified under Rule 10b-18 of the Exchange Act, as amended. Repurchases were made from cash on hand and cash generated from operations. For the year ended December 31, 2016, the Company repurchased 1,544,681 shares of common stock for $63.4 million with an average price per share of $41.06, which were all retired upon repurchase. Accumulated Other Comprehensive Income (Loss) Accumulated other comprehensive income (loss) is comprised of foreign currency translation adjustments; the effective portion of the gain (loss) on the Company’s cross-currency swap, which was designated and accounted for as a cash flow hedge (expired in 2016); and the unrealized (gains) losses on the Company’s debt security. The components of and changes in accumulated other comprehensive income (loss) are as follows: (U.S. Dollars, in thousands) Currency Translation Adjustments Derivatives Debt Security Accumulated Other Comprehensive Income (Loss) Balance at December 31, 2015 $ (4,389 ) $ 228 $ (2,071 ) $ (6,232 ) Other comprehensive loss (726 ) (360 ) (1,744 ) (2,830 ) Income taxes — 132 659 791 Reclassification adjustments to: Other expense, net — — 2,727 2,727 Income taxes — — (1,036 ) (1,036 ) Balance at December 31, 2016 $ (5,115 ) $ — $ (1,465 ) $ (6,580 ) Other comprehensive income 4,552 — 3,830 8,382 Income taxes — — (1,475 ) (1,475 ) Reclassification adjustments to: Other expense, net — — 5,585 5,585 Income taxes — — (2,125 ) (2,125 ) Balance at December 31, 2017 $ (563 ) $ — $ 4,350 $ 3,787

Revenue recognition and account

Revenue recognition and accounts receivable	12 Months Ended
	Dec. 31, 2017
Revenue Recognition And Accounts Receivable [Abstract]
Revenue recognition and accounts receivable	13. Revenue recognition and accounts receivable The table below presents net sales, which includes product sales and marketing service fees, for each of the years ended December 31, 2017, 2016, and 2015. For the year ended December 31, (U.S. Dollars, in thousands) 2017 2016 2015 Product sales $ 373,538 $ 355,652 $ 341,084 Marketing service fees 60,285 54,136 55,405 Net sales $ 433,823 $ 409,788 $ 396,489 Product sales primarily consist of stimulation devices and internal and external fixation products. Marketing service fees are received from MTF based on total sales of biologics tissues and relates solely to the Biologics SBU. Revenues exclude any value added or other local taxes, intercompany sales and trade discounts. Shipping and handling costs for products shipped to customers are included in cost of sales, and were $3.0 million, $2.0 million and $2.2 million for the years ended December 31, 2017, 2016 and 2015, respectively. BioStim BioStim revenue is largely attributable to the U.S. and is comprised of third-party payor transactions and wholesale revenue. The largest portion of BioStim revenue is derived from third-party payors. This includes commercial insurance carriers, health maintenance organizations, preferred provider organizations and governmental payors such as Medicare, in connection with the sale of the Company’s stimulation products. Revenue is recognized when the stimulation product is fitted to and accepted by the patient and all applicable documents that are required by the third-party payor have been obtained. Amounts paid by these third-party payors are generally based on fixed or allowable reimbursement rates. These revenues are recorded at the expected or preauthorized reimbursement rates, net of any contractual allowances or adjustments. Certain billings are subject to review by the third-party payors and may be subject to adjustment. Wholesale revenue is related to the sale of the Company’s bone growth stimulators directly to physicians and other healthcare providers. Wholesale revenues are typically recognized upon shipment and receipt of a confirming purchase order. Extremity Fixation and Spine Fixation Extremity Fixation and Spine Fixation products are distributed world-wide, with U.S. sales largely comprised of commercial revenue and international sales derived from commercial sales and through stocking distributor arrangements. Commercial revenue is related to the sale of the Company’s internal and external fixation products, generally representing hospital customers. Revenues are recognized when these products have been utilized and a confirming purchase order has been received from the hospital. Revenue for certain government entities is recorded on a cash-basis as collectability is not reasonably assured. For revenue from stocking distributor arrangements, the Company recognizes revenue once the product is delivered to the end customer (the “sell-through method”). Because the Company does not have reliable information about when its stocking distributors sell the product through to end customers, the Company uses cash collection from stocking distributors as a basis for revenue recognition under the sell-through method. Although in many cases the Company is legally entitled to the accounts receivable at the time of shipment, the Company has not recognized accounts receivables or any corresponding deferred revenues associated with stocking distributor transactions for which revenue is recognized on the sell-through method. For stocking distributor arrangements, the Company also considers whether to match the related cost of sales with revenue or to recognize cost of sales upon shipment. In making this assessment, the Company considers the financial viability of its stocking distributors based on their creditworthiness to determine if collectability of amounts sufficient to realize the costs of the products shipped is reasonably assured at the time of shipment to these stocking distributors. In instances where the stocking distributor is determined to be financially viable, the Company defers the costs of sales until the revenue is recognized. Biologics Biologics revenue is largely attributable to the U.S. and is primarily related to a collaborative arrangement with MTF, which extends through July 28, 2027, through which the Company markets tissue for bone repair and reconstruction under the brand names Trinity Evolution and Trinity ELITE. The Company has exclusive global marketing rights for Trinity Evolution as well as non-exclusive marketing rights for other products, and receives marketing fees from MTF based on total sales. MTF is considered the primary obligor in these arrangements and therefore the Company recognizes these marketing service fees on a net basis within net sales upon shipment of the product to the customer. Marketing service fees received from MTF were $60.3 million, or approximately 96% of total Biologics revenues, for the year ended December 31, 2017. As MTF is the Company’s single supplier for the Trinity Evolution and Trinity EITE tissue forms, which are derived from human cadaveric donors, any event or circumstance that would impact MTF’s continued access to donated human cadaveric tissue or the Company’s ability to market these tissues may adversely impact the Company’s financial results. Trade Accounts Receivable and Allowances Accounts receivable are analyzed on a quarterly basis to assess the adequacy of both reserves for doubtful accounts and contractual allowances. Revisions in allowances for doubtful accounts estimates are recorded as an adjustment to bad debt expense within sales and marketing expenses. Revisions to contractual allowances are recorded as an adjustment to net sales. The Company’s estimates are periodically tested against actual collection experience. The Company will generally sell receivables from certain Italian hospitals each year. During 2017, 2016, and 2015 the Company sold €9.8 million, €10.0 million, and €10.9 million ($11.2 million, $11.1 million, and $11.9 million) of receivables, respectively. The estimated related fee for 2017, 2016, and 2015 was $0.3 million, $0.4 million and $0.5 million, respectively, which is recorded as interest expense. Trade accounts receivables sold without recourse are removed from the balance sheet at the time of sale.

Business segment information

Business segment information	12 Months Ended
	Dec. 31, 2017
Segment Reporting [Abstract]
Business segment information	14. Business segment information We manage our business by our four SBUs: BioStim, Extremity Fixation, Spine Fixation, and Biologics. These SBUs represent the operating segments for which our Chief Executive Officer, who is also Chief Operating Decision Maker (the “CODM”), reviews financial information and makes resource allocation decisions among business units. The primary metric used by the CODM in managing the Company is non-GAAP net margin, an internal metric that the Company defines 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. Accordingly, our reporting segment information has been prepared based on our four SBUs. BioStim The BioStim SBU manufactures, distributes, and provides support services of market leading bone growth stimulator devices that enhance bone fusion. These Class III medical devices are indicated as an adjunctive, noninvasive treatment to improve fusion success rates in cervical and lumbar spine as well as a therapeutic treatment for non-spine fractures that have not healed (non-unions). This SBU uses distributors and sales representatives to sell its devices to hospitals, healthcare providers, and patients, primarily in the U.S. Extremity Fixation The Extremity Fixation SBU offers products and solutions that allow physicians to successfully treat a variety of orthopedic conditions unrelated to the spine. This SBU specializes in the design, development, and marketing of the Company’s orthopedic products used in fracture repair, deformity correction and bone reconstruction procedures. Extremity Fixation distributes its products through a network of distributors and sales representatives to sell orthopedic products to hospitals, and healthcare providers, globally. Spine Fixation The Spine Fixation SBU designs, develops and markets a broad portfolio of implant products used in surgical procedures of the spine. Spine Fixation distributes its products through a network of distributors and sales representatives to sell spine products to hospitals and healthcare providers, globally. Biologics The Biologics SBU provides a portfolio of regenerative products and tissue forms that allow physicians to successfully treat a variety of spinal and orthopedic conditions. This SBU specializes in the marketing of the Company’s exclusive regeneration tissue forms and distributes its tissues to hospitals and healthcare providers, primarily in the U.S., through a network of employed and independent sales representatives. Our partnership with MTF allows us to exclusively market our Trinity Evolution and Trinity ELITE tissue forms for musculoskeletal defects to enhance bony fusion. Corporate Corporate activities are comprised of the operating expenses of Orthofix International N.V. and its holding company subsidiaries, along with activities not necessarily identifiable within the four SBUs. The table below presents net sales by reporting segment: Year Ended December 31, 2017 2016 2015 (U.S. Dollars, in thousands) Net Sales Percent of Total Net Sales Net Sales Percent of Total Net Sales Net Sales Percent of Total Net Sales BioStim $ 185,900 42.9 % $ 176,561 43.1 % $ 164,955 41.6 % Extremity Fixation 103,242 23.8 % 102,683 25.1 % 96,034 24.2 % Spine Fixation 81,957 18.9 % 72,632 17.7 % 75,668 19.1 % Biologics 62,724 14.4 % 57,912 14.1 % 59,832 15.1 % Net sales $ 433,823 100.0 % $ 409,788 100.0 % $ 396,489 100.0 % The following table presents Non-GAAP net margin, and internal metric that the Company defines as gross profit less sales and marketing expense, by reporting segment: Year Ended December 31, (U.S. Dollars, in thousands) 2017 2016 2015 BioStim $ 77,369 $ 75,469 $ 67,878 Extremity Fixation 31,071 30,526 29,493 Spine Fixation 8,730 8,650 8,547 Biologics 25,692 26,891 27,226 Corporate (446 ) (888 ) (1,260 ) Non-GAAP net margin $ 142,416 $ 140,648 $ 131,884 General and administrative 74,388 74,404 87,157 Research and development 29,700 28,803 26,389 SEC / FCPA matters and related costs (2,483 ) 2,005 9,083 Charges related to U.S. Government resolutions — 14,369 — Operating income $ 40,811 $ 21,067 $ 9,255 Interest income (expense), net (416 ) 763 (489 ) Other expense, net (4,004 ) (2,806 ) (259 ) Income before income taxes $ 36,391 $ 19,024 $ 8,507 The following table presents depreciation and amortization by reporting segment: Year Ended December 31, (U.S. Dollars, in thousands) 2017 2016 2015 BioStim $ 2,133 $ 2,754 $ 2,933 Extremity Fixation 6,040 5,742 6,636 Spine Fixation 6,949 8,118 10,050 Biologics 752 1,011 1,157 Corporate 4,250 3,216 147 Total $ 20,124 $ 20,841 $ 20,923 Geographical information The following data includes net sales by geographic destination: (U.S. Dollars, in thousands) 2017 2016 2015 U.S. $ 345,145 $ 316,873 $ 305,505 Italy 17,059 16,664 15,655 United Kingdom 8,725 10,362 11,376 Brazil 10,356 11,334 13,512 Others 52,538 54,555 50,441 Net sales $ 433,823 $ 409,788 $ 396,489 The following data includes property, plant and equipment by geographic area: (U.S. Dollars, in thousands) 2017 2016 U.S. $ 34,008 $ 38,398 Italy 7,658 7,013 United Kingdom 382 617 Brazil 475 769 Others 2,616 2,119 Total $ 45,139 $ 48,916

Share-based compensation

Share-based compensation	12 Months Ended
	Dec. 31, 2017
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Share-based compensation	15. Share-based compensation At December 31, 2017, the Company had stock option and award plans, and an employee stock purchase plan. 2012 Long Term Incentive Plan The Board of Directors adopted the Orthofix International N.V. 2012 Long-Term Incentive Plan (the “2012 LTIP”) on April 13, 2012, subject to shareholder approval, which was subsequently provided by shareholder ratification. The 2012 LTIP provides for the grant of options to purchase shares of the Company’s common stock, stock awards (including restricted stock, unrestricted stock, and stock units), stock appreciation rights, performance-based awards and other equity-based awards. All of the Company’s employees and the employees of the Company’s subsidiaries and affiliates are eligible and may receive awards under the 2012 LTIP. In addition, the Company’s non-employee directors and consultants and advisors who perform services for the Company and the Company’s subsidiaries and affiliates may receive awards under the 2012 LTIP. Incentive share options, however, are only available to the Company’s employees. Awards granted under the 2012 LTIP expire no later than ten years after the date of grant. The Company reserves a total of 3,200,000 shares of common stock for issuance pursuant to the 2012 LTIP, subject to certain adjustments set forth in the 2012 LTIP. At December 31, 2017, there were 881,322 options outstanding under the 2012 LTIP Plan, of which 402,820 were exercisable. In addition, there were 381,204 shares of unvested restricted stock outstanding, some of which contain performance conditions, and 241,864 units of performance stock units outstanding under the plan as of December 31, 2017. 2004 Long Term Incentive Plan The 2004 Long Term Incentive Plan (the “2004 LTIP Plan”) reserved 3.1 million shares for issuance (in addition to shares (i) available for future awards as of June 29, 2004 under prior plans or (ii) that become available for future issuance upon the expiration or forfeiture after June 29, 2004 of awards upon prior plans). At December 31, 2017, there were 55,500 options outstanding under the 2004 LTIP Plan, all of which were exercisable; in addition, there were no shares of unvested restricted stock outstanding. Stock Purchase Plan The Orthofix International N.V. Amended and Restated Stock Purchase Plan (the “Stock Purchase Plan”) provides for the issuance of shares of the Company’s common stock to eligible employees and directors of the Company and its subsidiaries that elect to participate in the plan and acquire shares of common stock through payroll deductions (including executive officers). During each purchase period, eligible employees may designate between 1% and 25% of their compensation to be deducted for the purchase of common stock under the plan (or such other percentage in order to comply with regulations applicable to Employees domiciled in or resident of a member state of the European Union). For eligible directors, the designated percentage will be an amount equal to his or her annual or other director compensation paid in cash for the current plan year. The purchase price of the shares under the plan is equal to 85% of the fair market value on the first day of the plan year (which is a calendar year, running from January 1 to December 31) or, if lower, on the last day of the plan year. Due to the compensatory nature of such plan, the Company records the related share based compensation in the consolidated statement of operations. The aggregate number of shares reserved for issuance under the Stock Purchase Plan is 1,850,000. As of December 31, 2017, 1,504,445 shares had been issued. Share-Based Compensation Expense Share-based compensation expense is recorded in the same line of the consolidated statements of operations as the employee’s cash compensation. The following tables present the detail of share-based compensation by line item in the consolidated statements of operations as well as by award type, for the years ended December 31, 2017, 2016 and 2015: Year Ended December 31, (U.S. Dollars, in thousands) 2017 2016 2015 Cost of sales $ 486 $ 553 $ 440 Sales and marketing 1,471 1,230 1,304 General and administrative 9,671 13,132 5,051 Research and development 929 1,051 419 Total $ 12,557 $ 15,966 $ 7,214 Year Ended December 31, (U.S. Dollars, in thousands) 2017 2016 2015 Stock options $ 2,388 $ 2,021 $ 1,437 Time-based restricted stock awards 5,540 6,016 4,606 Performance-based restricted stock awards 462 5,716 — Performance-based and market-based restricted stock units 2,904 948 — Stock purchase plan 1,263 1,265 1,171 Total $ 12,557 $ 15,966 $ 7,214 The income tax benefit related to this expense was $3.4 million, $4.3 million, and $1.6 million for the years ended December 31, 2017, 2016, and 2015, respectively. Stock Options The fair value of service-based stock options is determined using the Black-Scholes valuation model, with such value recognized as expense over the service period, which is typically four years, net of actual forfeitures. The fair value of market-based stock options is determined at the date of the grant using the Monte Carlo valuation methodology, with such value recognized as expense over the requisite service period adjusted for forfeitures as they occur. The Monte Carlo methodology incorporates into the valuation the possibility that the market condition may not be satisfied. A summary of the Company’s assumptions used in determining the fair value of the stock options granted during the year is shown in the following table. Year Ended December 31, Assumptions: 2017 2016 2015 Expected term (in years) 4.5 4.5 4.5 Expected volatility 31.2 % 30.6% – 32.3% 31.1% – 31.6% Risk free interest rate 1.93 % 1.07% – 1.92% 1.37% – 1.54% Dividend yield — — — Weighted average grant date fair value $ 13.32 $ 11.79 $ 9.49 The expected term of the options granted is estimated based on a number of factors, including the vesting and expiration terms of the award, historical employee exercise behavior for both options that are currently outstanding and options that have been exercised or are expired, the historical volatility of the Company’s common stock and an employee’s average length of service. The risk-free interest rate is determined based upon a constant U.S. Treasury security rate with a contractual life that approximates the expected term of the option award. Expected volatility is estimated based on the historical volatility of the Company’s stock. Summaries of the status of the Company’s stock option plans as of December 31, 2017 and 2016 and changes during the year ended December 31, 2017 are presented below: Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term Outstanding at December 31, 2016 1,137,179 $ 36.05 Granted 165,595 $ 46.10 Exercised (152,027 ) $ 34.14 Forfeited (63,925 ) $ 42.50 Outstanding at December 31, 2017 1,086,822 $ 37.47 7.06 Vested and expected to vest at December 31, 2017 1,086,822 $ 37.47 7.06 Exercisable at December 31, 2017 608,320 $ 34.33 5.94 The table below summarizes the options outstanding and exercisable by exercise price range as of December 31, 2017: Options Outstanding Options Exercisable Range of Exercise Prices Number Outstanding Weighted Average Remaining Contractual Life Weighted Average Exercise Price Number Exercisable Weighted Average Exercise Price $21.78 – $27.97 111,874 5.08 $ 24.12 111,874 $ 24.12 $27.98 – $32.28 110,400 5.36 $ 31.12 91,326 $ 30.90 $33.12 – $33.12 140,475 7.50 $ 33.12 70,242 $ 33.12 $33.24 – $36.25 121,875 6.74 $ 35.51 83,213 $ 35.71 $36.46 – $38.40 39,750 8.55 $ 37.92 12,376 $ 37.64 $38.82 – $38.82 150,000 5.20 $ 38.82 150,000 $ 38.82 $39.66 – $41.37 65,500 6.12 $ 40.23 43,000 $ 40.25 $42.89 – $42.89 22,000 8.74 $ 42.89 5,500 $ 42.89 $44.39 – $44.39 163,138 8.50 $ 44.39 40,789 $ 44.39 $46.10 – $46.10 161,810 9.50 $ 46.10 — $ — $21.78 – $46.10 1,086,822 7.06 $ 37.47 608,320 $ 34.33 As of December 31, 2017, the unamortized compensation expense relating to options granted and expected to be recognized was $2.9 million. This amount is expected to be recognized through July 2021 or over a weighted average period of approximately 1.5 years. The total intrinsic value of options exercised was $2.2 million, $4.3 million and $0.7 million for the years ended December 31, 2017, 2016 and 2015, respectively. The aggregate intrinsic value of options outstanding and options exercisable as of December 31, 2017 is calculated as the difference between the exercise price of the underlying options and the market price of the Company’s common stock for the shares that had exercise prices that were lower than the $54.70 closing price of the Company’s stock on December 31, 2017. The aggregate intrinsic value of options outstanding was $18.7 million, $3.3 million and $8.0 million for the years ended December 31, 2017, 2016, and 2015, respectively. The aggregate intrinsic value of options exercisable was $12.4 million, $2.2 million and $4.3 million for the years ended December 31, 2017, 2016 and 2015, respectively. Time-based Restricted Stock Awards and Stock Units During the year ended December 31, 2017, the Company granted to employees and non-employee directors 143,469 shares of restricted stock or stock units, which vest at various dates through December 2021. The compensation expense, which represents the fair value of the stock measured at the market price at the date of grant, is recognized on a straight-line basis over the vesting period, which is typically four years, net of actual forfeitures. The aggregate fair value of restricted stock that vested during the years ended December 31, 2017, 2016 and 2015 was $7.3 million, $7.2 million and $6.1 million, respectively. Unamortized compensation expense related to restricted stock amounted to $11.0 million at December 31, 2017, and is expected to be recognized over a weighted average period of approximately 2.4 years. The aggregate intrinsic value of restricted stock outstanding was $17.8 million, $13.0 million and $14.9 million for the years ended December 31, 2017, 2016 and 2015, respectively. Performance-based Restricted Stock Awards The fair value of performance-based restricted stock awards is calculated based upon the closing stock price at the date of grant. Such value is recognized as expense over the derived requisite service period beginning in the period in which they are deemed probable to vest, net of actual forfeitures. Vesting probability is assessed based upon forecasted earnings and financial results. During the years ended December 31, 2017 or 2016, the Company did not grant any performance-based restricted stock awards to employees. During the year ended December 31, 2015, the Company granted to employees 110,660 shares of performance-based restricted stock, which vest based upon the achievement of certain earnings or return on invested capital targets as of and for any of the years ended December 31, 2016, 2017, or 2018. Approximately $0.5 million and $5.7 million of compensation expense has been recorded for the years ended December 31, 2017 and 2016, respectively, associated with these performance-based vesting restricted stock awards. No expense was recorded for the year ended December 31, 2015, related to performance-based restricted stock. The fair value of performance-based stock awards that vested during the year ended December 31, 2017, was $4.9 million. No performance-based stock awards vested during the years ended December 31, 2016 or 2015. Unamortized compensation expense related to performance-based restricted stock amounted to $0.4 million at December 31, 2017, which is contingent upon meeting certain performance-based vesting criteria and is expected to be recognized over a weighted average period of approximately 1.0 year. The aggregate intrinsic value of performance-based restricted stock awards outstanding was $3.0 million, $7.0 million and $7.6 million for the years ended December 31, 2017, 2016, and 2015, respectively. Performance-based and Market-based Restricted Stock Units The Company’s performance-based stock units (“PSUs”) consist of awards that contain either market conditions or performance conditions as a requirement for vesting. The fair value of market-based PSUs is determined at the date of the grant using the Monte Carlo valuation methodology, with any discounts for post-vesting restrictions estimated using the Chaffe Model. The Monte Carlo methodology incorporates into the valuation the possibility that the market condition may not be satisfied. Such value is recognized on a straight-line basis over the vesting period, net of actual forfeitures. During the years ended December 31, 2017 and 2016, the Company granted 94,902 and 96,245 shares, respectively, of market-based PSUs to executive officers and certain employees. The awards, if the market conditions are achieved, will be settled in shares of common stock, with one share of common stock issued per PSU if targets are achieved at the 100% level. Awards may be achieved at a minimum level of 50% and a maximum of 200%. The market conditions for the 2016 and 2017 awards are based on the Company’s stock achieving certain total shareholder return targets relative to specified index companies during a 3-year performance period beginning in July 2016 and July 2017, respectively. The Company recorded $2.9 million and $0.9 million in compensation expense for the years ended December 31, 2017 and 2016, respectively, and no expense for the year ended December 31, 2015, related to market-based PSUs. Unamortized compensation expense for market-based PSUs amounted to $5.9 million at December 31, 2017, and is expected to be recognized over a weighted average period of approximately 2.0 years. The aggregate intrinsic value of market-based PSUs outstanding was $10.2 million, $3.5 million, and $0.0 million for the years ended December 31, 2017, 2016, and 2015, respectively. The fair value of performance-based PSUs is calculated based upon the closing stock price at the date of grant. Such value is recognized as expense over the derived requisite service period beginning in the period in which the awards are deemed probable to vest. Vesting probability is assessed based upon forecasted earnings and financial results. During the year ended December 31, 2015, the Company granted 55,330 shares of performance-based PSUs to employees, which vest based upon the achievement of certain earnings or return on invested capital targets for the year ended December 31, 2018. The Company has not recorded any compensation expense for the years ended December 31, 2017, 2016, or 2015 related to these 2015 performance-based PSUs as the requisite service period has not yet begun. Unamortized compensation expense related to these 2015 performance-based PSUs amounts to $1.8 million at December 31, 2017 and is expected to be recognized over a weighted average period of approximately 1.0 year, if all performance conditions are met. The aggregate intrinsic value of performance-based PSUs outstanding was $3.0 million, $2.0 million, and $2.2 million for the years ended December 31, 2017, 2016, and 2015, respectively. A summary of the status of our restricted stock and stock units as of December 31, 2017 and 2016 and changes during the year ended December 31, 2017 are presented below: Time-based Awards and Units Performance-based Awards Performance-based or Market-based Stock Units Shares Weighted Average Grant Date Fair Value Shares Weighted Average Grant Date Fair Value Shares Weighted Average Grant Date Fair Value Non-vested as of December 31, 2016 358,919 $ 38.27 192,310 $ 34.45 151,575 $ 43.54 Granted 143,469 $ 46.42 — $ — 94,902 $ 54.49 Vested (157,807 ) $ 37.04 (136,980 ) $ 34.99 — $ — Cancelled (18,707 ) $ 38.59 — $ — (4,613 ) $ 49.09 Non-vested as of December 31, 2017 325,874 $ 42.44 55,330 $ 33.12 241,864 $ 47.73

Defined Contribution Plans and

Defined Contribution Plans and deferred compensation	12 Months Ended
	Dec. 31, 2017
Compensation And Retirement Disclosure [Abstract]
Defined contribution plans and deferred compensation	16. Defined contribution plans and deferred compensation Defined Contribution Plans Orthofix Inc. sponsors a defined contribution plan (the “401(k) Plan”) covering substantially all full time U.S. employees. The 401(k) Plan allows participants to contribute up to 15% of their pre-tax compensation, subject to certain limitations, with the Company matching 100% of the first 2% of the employee’s base compensation and 50% of the next 4% of the employee’s base compensation if contributed to the 401(k) Plan. During the years ended December 31, 2017, 2016 and 2015, expenses incurred relating to the 401(k) Plan, including matching contributions, were approximately $2.0 million, $1.9 million and $2.0 million, respectively. The Company also operates defined contribution pension plans for its international employees meeting minimum service requirements. The Company’s expenses for such pension contributions during each of the years ended December 31, 2017, 2016 and 2015 were $1.1 million, $1.0 million and $1.1 million, respectively. Deferred Compensation Plans Under Italian Law, our Italian subsidiary accrues, on behalf of its employees, deferred compensation, which is paid on termination of employment. The accrual for deferred compensation is based on a percentage of the employee’s current annual remuneration plus an annual charge. Deferred compensation is also accrued for the leaving indemnity payable to agents in case of dismissal, which is regulated by a national contract and is equal to approximately 3.5% of total commissions earned from the Company. The Company’s relations with its Italian employees, who represent 21.5% of total employees at December 31, 2017, are governed by the provisions of a National Collective Labor Agreement setting forth mandatory minimum standards for labor relations in the metal mechanic workers industry. The Company is not a party to any other collective bargaining agreement. The Orthofix Deferred Compensation Plan, administered by the Board of Directors of the Company, effective January 1, 2007, and as amended and restated effective January 1, 2009, is a plan intended to allow a select group of key management and highly compensated employees of the Company to defer the receipt of compensation that would otherwise be payable to them. As of January 1, 2011 the Company disallowed further contributions into the plan and any new plan participants. Distributions are made in accordance with the requirements of Code Section 409A. The Company’s expense for both deferred compensation plans described above was approximately $0.1 million for each of the years ended December 31, 2017, 2016, and 2015. There were $0.2 million in deferred compensation payments made in 2017, $0.1 million in 2016, and none in 2015. The balance in other long-term liabilities as of December 31, 2017 and 2016 was $1.4 million and $1.5 million, respectively, and represents the amount which would be payable if all the employees and agents had terminated employment at that date.

Income taxes

Income taxes	12 Months Ended
	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Income taxes	17. Income taxes Income (loss) from continuing operations before provision for income taxes consisted of the following: Year Ended December 31, (U.S. Dollars, in thousands) 2017 2016 2015 U.S. $ 27,774 $ 23,006 $ 15,480 Non-U.S. 8,617 (3,982 ) (6,973 ) Income before income taxes $ 36,391 $ 19,024 $ 8,507 The provision for income taxes on continuing operations consists of the following: Year Ended December 31, (U.S. Dollars, in thousands) 2017 2016 2015 U.S. Current $ 3,620 $ 558 $ 6,792 Deferred 20,222 9,296 (1,146 ) 23,842 9,854 5,646 Non-U.S. Current 4,062 4,509 3,661 Deferred 1,196 1,164 1,542 5,258 5,673 5,203 Income tax expense $ 29,100 $ 15,527 $ 10,849 The rate reconciliation for continuing operations presented below is based on the U.S. federal income tax rate, rather than the Company’s country of domicile tax rate. The Company believes, given the large proportion of taxable income earned in the United States, such disclosure is more meaningful. 2017 2016 2015 (U.S. Dollars, in thousands, except percentages) Amount Percent Amount Percent Amount Percent Statutory U.S. federal income tax rate $ 12,737 35.0 % $ 6,658 35.0 % $ 2,978 35.0 % State taxes, net of U.S. federal benefit 1,598 4.4 395 2.1 521 6.1 Foreign rate differential, including withholding taxes (3,849 ) (10.6 ) (805 ) (4.2 ) (1,934 ) (22.7 ) Charges related to U.S. Government resolutions — — 2,050 10.8 — — Valuation allowances, net 3,548 9.7 6,149 32.3 10,952 128.7 Change in estimate on compensation expenses — — (2,151 ) (11.3 ) — — Italian subsidiary intangible asset (381 ) (1.0 ) (1,477 ) (7.8 ) (2,076 ) (24.4 ) Change of intention for foreign earnings — — 1,300 6.8 — — Domestic manufacturing deduction (818 ) (2.2 ) — — (469 ) (5.5 ) Unrecognized tax benefits, net of settlements 6,002 16.5 3,049 16.0 406 4.8 Impact of the Tax Act 8,347 22.9 — — — — Other, net 1,916 5.3 359 1.9 471 5.5 Income tax expense/effective rate $ 29,100 80.0 % $ 15,527 81.6 % $ 10,849 127.5 % On December 22, 2017, the Tax Act was signed into law making significant changes to the Internal Revenue Code. Changes include, but are not limited to, a U.S. corporate rate decrease from 35% to 21% effective for tax years beginning after December 31, 2017, the transition of U.S. international taxation from a worldwide tax system to a territorial system, and a one-time transition tax on the mandatory deemed repatriation of cumulative foreign earnings as of December 31, 2017. The Company has calculated its best estimate of the impact of the Tax Act in the 2017 income tax provision in accordance with its understanding of the Tax Act and guidance available as of the date of this filing. As a result, the Company recorded $8.3 million of additional income tax expense in the fourth quarter of 2017, the period in which the legislation was enacted. The provisional amount related to the remeasurement of certain deferred tax assets and liabilities, based on the rates at which they are expected to reverse in the future was $8.6 million. The provisional amount related to the one-time transition tax on the mandatory deemed repatriation of foreign earnings was zero. The Company also recorded a benefit of $0.3 million related to an income tax liability recorded in 2016 related to repatriation of earnings from our subsidiary in Puerto Rico. On December 22, 2017, Staff Accounting Bulletin No. 118 (“SAB 118”) was issued to address the application of U.S. GAAP in situations when a registrant does not have the necessary information available, prepared, or analyzed (including computations) in reasonable detail to complete the accounting for certain income tax effects of the Tax Act. In accordance with SAB 118, we have determine that the $8.6 million of the deferred tax expense recorded in connection with the remeasurement of certain deferred tax assets and liabilities and the zero transition tax on the mandatory deemed repatriation of foreign earnings was a provisional amount and a reasonable estimate at December 31, 2017. Additional work is necessary for a more detailed analysis of the Company’s deferred tax assets and liabilities and its historical foreign earnings as well as potential correlative adjustments. Any subsequent adjustment to those amounts will be recorded to current tax expense in the quarter of 2018 when the analysis is complete. During 2016, the Company revised its estimate relating to the deductibility of certain compensation expenses. This change in estimate reduced income tax expense and increased net income from continuing operations by $2.4 million and increased earnings per share by $0.13 for the year ended December 31, 2016. The Company’s deferred tax assets and liabilities are as follows: December 31, (U.S. Dollars, in thousands) 2017 2016 Intangible assets and goodwill $ 2,271 $ 2,628 Inventories and related reserves 11,298 17,665 Deferred revenue and cost of goods sold 6,816 11,263 Other accruals and reserves 2,336 4,066 Accrued compensation 4,054 6,747 Allowance for doubtful accounts 2,617 2,898 Accrued interest — 4,621 Net operating loss carryforwards 42,675 37,930 Other, net 2,369 3,032 74,436 90,850 Valuation allowance (46,271 ) (41,701 ) Deferred tax asset $ 28,165 $ 49,149 Withholding taxes (381 ) (648 ) Property, plant and equipment (4,469 ) (1,176 ) Deferred tax liability (4,850 ) (1,824 ) Net deferred tax assets $ 23,315 $ 47,325 The Company accounts for income taxes using the asset and liability method, under which deferred tax assets and liabilities are recognized for the expected future tax consequences of temporary differences between the financial reporting and income tax basis of assets and liabilities, and for operating losses and credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates in effect for the years in which those items are expected to be realized. Tax law and rate changes are recorded in the period such changes are enacted. The Company establishes a valuation allowance when it is more likely than not that certain deferred tax assets will not be realized in the foreseeable future. The valuation allowance is primarily attributable to net operating loss carryforwards and temporary differences in certain foreign jurisdictions. The net increase in the valuation allowance of $4.6 million during the year principally relates to the increase of valuation allowances on net operating loss carryforwards in foreign jurisdictions. The Company has state net operating loss carryforwards of approximately $11.6 million that will begin to expire in 2018. Additionally, the Company has net operating loss carryforwards in various foreign jurisdictions of approximately $167.3 million that begin to expire in 2018, the majority of which relate to the Company’s Netherlands operations. During 2016, the Company changed its intention related to unremitted foreign earnings in its Puerto Rico subsidiary and certain United Kingdom subsidiaries. As a result of the change in intention, the Company recorded $ 1.3 million of income tax expense for the remitted and unremitted earnings in each of these subsidiaries. During the first quarter of 2017, the Company changed its intention related to unremitted foreign earnings in its Seychelles subsidiary. The tax impact was minimal. The Company’s current intention is to indefinitely reinvest substantially all of its other unremitted foreign earnings (residing outside Curaçao). As an entity incorporated in Curaçao, “foreign earnings” refer to both U.S. and non-U.S. earnings. Furthermore, only income sourced in the U.S. is subject to U.S. income tax. Unremitted foreign earnings decreased from $372.5 million at December 31, 2016 to $335.7 million at December 31, 2017. Determining the additional income tax that may be payable if such earnings are repatriated is not practicable. The Company records a benefit for uncertain tax positions when the weight of available evidence indicates that it is more likely than not, based on an evaluation of the technical merits, that the tax position will be sustained on audit. The tax benefit is measured as the largest amount that is more than 50% likely to be realized upon settlement. The Company re-evaluates income tax positions periodically to consider changes in facts or circumstances such as changes in or interpretations of tax law, effectively settled issues under audit, and new audit activity. The Company includes interest and any applicable penalties related to income tax issues as part of income tax expense in its consolidated financial statements. The Company’s unrecognized tax benefit was $22.5 million and $18.4 million for the years ended December 31, 2017 and 2016, respectively. The Company recorded interest and penalties on unrecognized tax benefits of $2.3 million, $2.1 million, and $0.2 million for the years ended December 31, 2017, 2016, and 2015, respectively, and had approximately $5.3 million and $3.0 million accrued for payment of interest and penalties as of December 31, 2017 and 2016, respectively. The entire amount of unrecognized tax benefits, including interest, would favorably impact the Company’s effective tax rate if recognized. The Company believes it is reasonably possible that, in the next 12 months, the amount of unrecognized tax benefits related to the resolution of federal, state and foreign matters could be reduced by $2.4 million to $3.6 million as audits close and statutes expire. A reconciliation of the gross unrecognized tax benefits (excluding interest and penalties) for the years ended December 31, 2017, 2016, and 2015 follows: (U.S. Dollars, in thousands) 2017 2016 2015 Balance as of January 1, $ 18,384 $ 15,763 $ 15,597 Additions for current year tax positions 787 77 332 Increases (decreases) for prior year tax positions 3,361 2,551 (86 ) Settlements of prior year tax positions — — — Expiration of statutes (10 ) (7 ) (80 ) Balance as of December 31, $ 22,522 $ 18,384 $ 15,763 The Company and its subsidiaries file income tax returns in the U.S. federal jurisdiction and in certain state and foreign jurisdictions, including Italy and the United Kingdom. The statute of limitations with respect to federal and state tax filings is closed for years prior to 2012. The statute of limitations with respect to the major foreign tax filing jurisdictions is closed for years prior to 2012. During the third quarter of 2015, the Internal Revenue Service commenced an examination of the Company’s federal income tax return for 2012. The Company reasonably expects to conclude this examination in the first half of 2018 with no material impact on the financial statements. In October 2016, the Company was notified of an examination of its federal income tax return for 2013 and in December 2017, the examination for 2013 was concluded with no change. In November 2017, the Company was notified of an examination of its federal income tax return for 2015. The Company cannot reasonably determine if this examination, or any state and local tax examinations, will have a material impact on its financial statements and cannot predict the timing regarding resolution of these tax examinations.

Earnings per share (EPS)

Earnings per share (EPS)	12 Months Ended
	Dec. 31, 2017
Earnings Per Share [Abstract]
Earnings per share (EPS)	18. Earnings per share (EPS) Basic EPS is computed using the weighted average number of common shares outstanding during each of the respective years. Diluted EPS is computed using the weighted average number of common and common equivalent shares outstanding during each of the respective years using the treasury stock method. The difference between basic and diluted shares, if any, largely results from common equivalent shares, which represents the dilutive effect of the assumed exercise of certain outstanding share options, the assumed vesting of restricted stock granted to employees and directors, or the satisfaction of certain necessary conditions for contingently issuable shares (see Note 15). For each of the three years ended December 31, 2017, no adjustments were made to net income (loss) for purposes of calculating basic and diluted EPS. The following is a reconciliation of the weighted average shares used in the diluted EPS computations. Year Ended December 31, 2017 2016 2015 Weighted average common shares-basic 18,117,405 18,144,019 18,795,194 Effect of diluted securities: Unexercised stock options and employee stock purchase plan 209,691 161,092 — Unvested time-based restricted stock awards 123,592 138,291 — Unvested performance-based restricted stock awards 48,057 19,759 — Weighted average common shares-diluted 18,498,745 18,463,161 18,795,194 No adjustment was made for any common stock equivalents for the year ended December 31, 2015, because the effect would have been anti-dilutive. There were 418,859, 542,555 and 1,033,731 outstanding options, restricted stock, and performance-based or market-based equity awards not included in the diluted earnings per share computation for the years ended December 31, 2017, 2016 and 2015, respectively, because inclusion of these awards was anti-dilutive or, for performance-based and market-based awards, all necessary conditions have not been satisfied by the end of the respective period.

Quarterly financial data (unaud

Quarterly financial data (unaudited)	12 Months Ended
	Dec. 31, 2017
Quarterly Financial Information Disclosure [Abstract]
Quarterly financial data (unaudited)	19. Quarterly financial data (unaudited) 2017 (U.S. Dollars, in thousands, except per share data) 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Year Net sales $ 102,738 $ 108,942 $ 105,247 $ 116,896 $ 433,823 Cost of sales 22,581 23,177 23,717 23,562 93,037 Gross profit 80,157 85,765 81,530 93,334 340,786 Operating expense 74,238 77,767 72,496 75,474 299,975 Operating income 5,919 7,998 9,034 17,860 40,811 Net income (loss) from continuing operations (2,308 ) 4,735 3,348 1,516 7,291 Net income (loss) $ (2,654 ) $ 3,853 $ 3,456 $ 1,568 $ 6,223 Net income (loss) per common share — basic: Net income (loss) from continuing operations $ (0.13 ) $ 0.26 $ 0.18 $ 0.08 $ 0.40 Net income (loss) $ (0.15 ) $ 0.21 $ 0.19 $ 0.09 $ 0.34 Net income (loss) per common share — diluted: Net income (loss) from continuing operations $ (0.13 ) $ 0.26 $ 0.18 $ 0.08 $ 0.39 Net income (loss) $ (0.15 ) $ 0.21 $ 0.19 $ 0.08 $ 0.34 2016 (U.S. Dollars, in thousands, except per share data) 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Year Net sales $ 98,679 $ 104,075 $ 98,497 $ 108,537 $ 409,788 Cost of sales 22,137 22,516 19,880 23,320 87,853 Gross profit 76,542 81,559 78,617 85,217 321,935 Operating expense 69,467 84,254 69,346 77,801 300,868 Operating income (loss) 7,075 (2,695 ) 9,271 7,416 21,067 Net income (loss) from continuing operations 4,576 (6,346 ) 10,384 (5,117 ) 3,497 Net income (loss) $ 3,840 $ (7,444 ) $ 9,896 $ (3,236 ) $ 3,056 Net income (loss) per common share — basic: Net income (loss) from continuing operations $ 0.25 $ (0.35 ) $ 0.57 $ (0.29 ) $ 0.19 Net income (loss) $ 0.21 $ (0.41 ) $ 0.55 $ (0.18 ) $ 0.17 Net income (loss) per common share — diluted: Net income (loss) from continuing operations $ 0.24 $ (0.35 ) $ 0.56 $ (0.29 ) $ 0.19 Net income (loss) $ 0.20 $ (0.41 ) $ 0.54 $ (0.18 ) $ 0.17

Significant accounting polici27

Significant accounting policies (Policies)	12 Months Ended
	Dec. 31, 2017
Accounting Policies [Abstract]
Market risk	Market risk In the ordinary course of business, the Company is exposed to the impact of changes in interest rates and foreign currency fluctuations. The Company’s objective is to limit the impact of such movements on earnings and cash flows. In order to achieve this objective, the Company seeks to balance its non-U.S. dollar denominated income and expenditures. During 2016 and 2015, the Company made use of a cross-currency swap agreement to manage cash flow exposure generated from foreign currency fluctuations. This cross-currency swap matured and was settled on December 30, 2016. The financial statements for operations outside the United States are generally maintained in their local currency. All foreign currency denominated balance sheet accounts, except shareholders’ equity, are translated to U.S. dollars at year end exchange rates and revenue and expense items are translated at weighted average rates of exchange prevailing during the year. Gains and losses resulting from the translation of foreign currency are recorded in the accumulated other comprehensive income (loss) component of shareholders’ equity. Transactional foreign currency gains and losses, including those generated from intercompany operations, are included in other expense, net and were a gain of $1.9 million, and losses of less than $0.1 million and $3.5 million for the years ended December 31, 2017, 2016 and 2015, respectively.
Financial instruments and concentration of credit risk	Financial instruments and concentration of credit risk Financial instruments that could subject the Company to a concentration of credit risk consist primarily of cash and cash equivalents and accounts receivable. Generally, the cash is held at large financial institutions and cash equivalents consist of highly liquid money market funds. The Company performs ongoing credit evaluations of customers, generally does not require collateral, and maintains a reserve for potential credit losses. The Company believes that a concentration of credit risk related to the accounts receivable is limited because customers are geographically dispersed and end users are diversified across several industries. Net sales to our customers based in Europe were approximately $57 million in 2017, which results in a substantial portion of our trade accounts receivable balance as of December 31, 2017. It is at least reasonably possible that changes in global economic conditions and/or local operating and economic conditions in the regions these distributors operate, or other factors, could affect the future realization of these accounts receivable balances.
Cash, cash equivalents and restricted cash	Cash, cash equivalents and restricted cash The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. In 2016, restricted cash consisted of amounts held in escrow as of December 31, 2016, to fund the payment of settlement amounts for charges related to U.S. Government resolutions, as further discussed in Note 11.
Derivative Instruments	Derivative Instruments The Company manages its exposure to fluctuating cash flows resulting from changes in interest rates and foreign exchange rates within the consolidated financial statements according to its hedging policy. The policy requires the Company to formally document the relationship between the hedging instrument and hedged item, as well as its risk-management objective and strategy for undertaking the hedge transaction. For instruments designated as a cash flow hedge, the Company formally assesses (both at the hedge’s inception and on an ongoing basis) whether the derivative used in the hedging transaction has been effective in offsetting changes in the cash flows of the hedged item and whether such derivative may be expected to remain effective in future periods. If it is determined that a derivative is not (or has ceased to be) effective as a hedge, the Company discontinues the related hedge accounting prospectively. The Company records all derivatives as either assets or liabilities on the balance sheet at their respective fair values. For a cash flow hedge, the effective portion of the derivative’s change in fair value (i.e., gains or losses) is initially reported as a component of other comprehensive income, net of related taxes, and subsequently reclassified into net earnings in the period the hedged transaction affects earnings. On September 30, 2010, the Company entered into a cross-currency swap agreement to manage its cash flows related to foreign currency exposure for a portion of an intercompany note receivable of a U.S. dollar functional currency subsidiary that was denominated in Euro. Both the cross-currency swap and the related Euro denominated intercompany note matured and were settled on December 30, 2016.
Research and development costs	Research and development costs Expenditures related to the collaborative arrangement with MTF Biologics (“MTF”) are expensed based on the terms of the related agreement. Expenditures incurred under the collaborative arrangement with MTF totaled $0.9 million in 2017 and $1.3 million in 2016. No expenditures were incurred in 2015. Expenditures for research and development are expensed as incurred.
Recently issued income tax accounting guidance	Recently issued income tax accounting guidance In December 2017, the SEC staff issued Staff Accounting Bulletin No. 118 (“SAB 118”) to address the application of U.S. GAAP in situations when a registrant does not have the necessary information available, prepared, or analyzed (including computations) in reasonable detail to complete the accounting for certain income tax effects of the Tax Cuts and Jobs Act (the “Tax Act”). See Note 17 for further discussion. Further, in January 2018, the FASB released guidance on the accounting for tax on the global intangible low taxed income (“GILTI”) provisions of the Tax Act. The GILTI provisions impose a tax on foreign income in excess of deemed return on tangible assets of foreign corporations. The guidance indicated that either accounting for deferred taxes related to GILTI inclusion or to treat any taxes on GILTI inclusion as a period cost are both acceptable methods subject to an accounting policy election. The Company is currently evaluating this policy decision.
Recently issued accounting standards	Recently issued accounting standards Topic Description of Guidance Effective Date Status of Company's Evaluation Revenue Recognition (ASU 2014-09, as amended) Requires entities to recognize revenue in a way that depicts the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled to in exchange for those goods or services. Applied either retrospectively or as a cumulative effect adjustment as of the adoption date. January 1, 2018 In 2015, the Company established a cross-functional implementation team to analyze the impact of the standard on the Company's contract portfolio by reviewing the Company's current accounting policies and practices to identify potential differences that would result from applying the requirements of the new standard to the Company's contracts. In addition, the implementation team identified and implemented appropriate changes to the Company's business processes, systems, and controls to support recognition and disclosure under the new standard. The implementation team has reported the findings and progress of the project to management and to the Audit Committee on a frequent basis over the last two years. In the fourth quarter of 2017, the Company finalized its assessment of the new standard, including the review of contracts within each SBU and the drafting of new policies and procedures. Adoption of this ASU has a material impact related to the timing of revenue recognition, primarily for Extremity Fixation and Spine Fixation product sales to stocking distributors, which are currently accounted for using the sell-through method. Subsequent to adoption, revenue associated with these sales will be recorded at the time of the sale instead of deferring recognition until cash is received. The Company will adopt the standard using the modified retrospective transition method and will record a cumulative effect adjustment as of January 1, 2018, which will result in a significant increase in accounts receivable and a decrease in inventories, with these changes offset by an adjustment to the Company's opening retained earnings of approximately $5 million. Prior periods will not be retrospectively adjusted. Adopting this guidance will also result in material changes to the Company's disclosures for revenue recognition and contracts with customers. Financial Instruments (ASU 2016-01) Requires entities to measure equity investments, except in limited circumstances, at fair value and recognize any changes in fair value in net income. Applied prospectively. January 1, 2018 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. Leases (ASU 2016-02) Requires a lessee to recognize lease assets and lease liabilities for leases classified as operating leases. Applied using a modified retrospective approach. January 1, 2019 The Company is currently in process of establishing a cross-functional implementation team to analyze the impact of the standard on the Company's lease portfolio and to evaluate the impact this ASU may have on its consolidated financial statements; however, the Company expects this guidance will materially impact the Company's balance sheet, resulting in current operating lease obligations being reflected on the consolidated balance sheet. Income Taxes (ASU 2016-16) Reduces complexity by requiring the recognition of current and deferred income taxes for an intra-entity asset transfer, other than inventory, when the transfer occurs. Applied using a modified retrospective approach. January 1, 2018 During the third and fourth quarters of 2017, the Company executed two intra-entity asset transfers that resulted in prepaid income taxes of $8.6 million. The Company will adopt the new standard using a modified retrospective approach as of January 1, 2018, which will result in a reduction of prepaid income taxes and an increase in deferred tax assets with these change offset by an adjustment to the Company's opening retained earnings of approximately $2.1 million. However, the Company does not expect this guidance to have a material impact relating to its consolidated statements of operations and comprehensive income (loss) or to its consolidated statements of cash flows. Statement of Cash Flows (ASU 2016-18) Reduces diversity in classification and presentation of restricted cash, including transfers between cash and restricted cash, on the statement of cash flows. Applied retrospectively. January 1, 2018 The Company believes this ASU will materially impact its consolidated statement of cash flows. Adoption of this ASU is expected to result in an increase in net cash from operating activities of $14.4 million for the year ended December 31, 2016 and would have resulted in a decrease in net cash from operating activities of $14.4 million for the year ended December 31, 2017, if this ASU had been early adopted. Goodwill (ASU 2017-04) Eliminates Step 2 of the current goodwill impairment test, which requires a hypothetical purchase price allocation to measure goodwill impairment. A goodwill impairment loss will instead be measured at the amount by which a reporting unit's carrying value exceeds its fair value, not to exceed the recorded amount of goodwill. January 1, 2020 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements. However, the Company does not expect this ASU to have a significant impact on its financial statements or disclosures. Comprehensive Income (ASU 2018-02) Allows entities to reclassify from accumulated other comprehensive income to retained earnings stranded tax effects resulting from the Tax Act. January 1, 2019 The Company is currently evaluating the impact this ASU may have on its consolidated financial statements.

Inventories (Tables)

Inventories (Tables)	12 Months Ended
	Dec. 31, 2017
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories are valued at the lower of cost or estimated net realizable value, after provision for excess, obsolete or impaired items, which is reviewed and updated on a periodic basis by management. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at our manufacturing facility in Italy, cost is determined on a weighted-average basis, which approximates the first-in, first-out (“FIFO”) method. For inventory procured or produced, whether internally or through contract manufacturing arrangements, at our manufacturing facility in Texas, standard costs, which approximates actual cost on the FIFO method, is used to value inventory. Standard costs are reviewed annually by management, or more often in the event circumstances indicate a change in cost has occurred. Work-in-process, finished products, field inventory and consignment inventory include material, labor and production overhead costs. Field inventory represents immediately saleable finished products inventory that is in the possession of the Company’s independent sales representatives. Consignment inventory 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 yet been met. Once all revenue recognition criteria have been met, the revenue and associated cost of sales are recognized. December 31, (U.S. Dollars, in thousands) 2017 2016 Raw materials $ 6,067 $ 7,978 Work-in-process 12,487 9,505 Finished products 11,244 15,985 Field inventory 40,262 22,021 Consignment inventory 8,935 4,428 Deferred cost of sales 2,335 3,429 Inventories $ 81,330 $ 63,346

Property, plant and equipment (

Property, plant and equipment (Tables)	12 Months Ended
	Dec. 31, 2017
Property Plant And Equipment [Abstract]
Schedule of Useful Lives of Assets	The useful lives of these assets are as follows: Years Buildings 25 to 33 Plant and equipment 1 to 10 Instrumentation 3 to 4 Computer software 3 to 7 Furniture and fixtures 4 to 8
Schedule of Property Plant and Equipment	The assets and related accumulated depreciation are adjusted for property retirements and disposals, with the resulting gain or loss included in earnings. Fully depreciated assets remain in the accounts until retired from service. December 31, (U.S. Dollars, in thousands) 2017 2016 Cost Buildings $ 3,725 $ 3,225 Plant and equipment 47,588 43,745 Instrumentation 75,818 71,962 Computer software 48,604 44,720 Furniture and fixtures 7,605 8,308 Construction in progress 769 1,907 184,109 173,867 Accumulated depreciation (138,970 ) (124,951 ) Property, plant and equipment, net $ 45,139 $ 48,916

Patents and other intangible 30

Patents and other intangible assets (Tables)	12 Months Ended
	Dec. 31, 2017
Goodwill And Intangible Assets Disclosure [Abstract]
Schedule of Patents and Other Intangible Assets	December 31, (U.S. Dollars, in thousands) 2017 2016 Cost Patents $ 38,621 $ 38,348 License and other 10,276 7,611 Trademarks—finite lived 533 319 49,430 46,278 Accumulated amortization Patents (34,151 ) (34,717 ) License and other (4,625 ) (3,962 ) Trademarks—finite lived (193 ) (138 ) (38,969 ) (38,817 ) Patents and other intangible assets, net $ 10,461 $ 7,461
Schedule of Future Amortization Expense	Future amortization expense for intangible assets is estimated as follows: (U.S. Dollars, in thousands) Amortization 2018 $ 2,352 2019 1,909 2020 1,366 2021 1,321 2022 1,314 Thereafter 2,199 Total $ 10,461

Goodwill (Tables)

Goodwill (Tables)	12 Months Ended
	Dec. 31, 2017
Goodwill And Intangible Assets Disclosure [Abstract]
Schedule of Net Carrying Amount of Goodwill	The following table presents the net carrying value of goodwill by reportable segment: December 31, (U.S. Dollars, in thousands) 2017 2016 BioStim $ 42,678 $ 42,678 Extremity Fixation — — Spine Fixation — — Biologics 10,887 10,887 Goodwill $ 53,565 $ 53,565

Other current liabilities (Tabl

Other current liabilities (Tables)	12 Months Ended
	Dec. 31, 2017
Payables And Accruals [Abstract]
Summary of Other Current Liabilities	December 31, (U.S. Dollars, in thousands) 2017 2016 Accrued expenses $ 6,984 $ 6,155 Salaries, bonuses, commissions and related taxes payable 24,635 19,636 Accrued distributor commissions 9,192 9,379 Accrued legal and settlement expenses 7,673 23,081 Non-income taxes payable 3,180 7,301 Other payables 9,631 3,536 Other current liabilities $ 61,295 $ 69,088

Fair value measurements (Tables

Fair value measurements (Tables)	12 Months Ended
	Dec. 31, 2017
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	(U.S. Dollars, in thousands) Balance December 31, 2017 Level 1 Level 2 Level 3 Assets Collective trust funds $ 100 $ — $ 100 $ — Treasury securities 556 556 — — Debt security 16,050 — — 16,050 Total $ 16,706 $ 556 $ 100 $ 16,050 Liabilities Deferred compensation plan $ (1,379 ) $ — $ (1,379 ) $ — Total $ (1,379 ) $ — $ (1,379 ) $ — (U.S. Dollars, in thousands) Balance December 31, 2016 Level 1 Level 2 Level 3 Assets Collective trust funds $ 1,584 $ — $ 1,584 $ — Treasury securities 467 467 — — Certificates of deposit 468 468 — — Debt security 12,220 — — 12,220 Total $ 14,739 $ 935 $ 1,584 $ 12,220 Liabilities Deferred compensation plan $ (1,452 ) $ — $ (1,452 ) $ — Total $ (1,452 ) $ — $ (1,452 ) $ —
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) 2017 2016 Balance at January 1 $ 12,220 $ 12,658 Accrued interest income — 1,306 Gains or losses recorded for the period Recognized in net income (5,585 ) (2,727 ) Recognized in other comprehensive income 9,415 983 Balance at December 31 $ 16,050 $ 12,220

Commitments (Tables)

Commitments (Tables)	12 Months Ended
	Dec. 31, 2017
Commitments And Contingencies Disclosure [Abstract]
Schedule of Future Minimum Lease Payments Under Operating Leases	Future minimum lease payments under operating leases as of December 31, 2017 are as follows: (U.S. Dollars, in thousands) 2018 $ 3,017 2019 2,018 2020 1,240 2021 1,575 2022 1,600 Thereafter 12,156 Total $ 21,606

Shareholders' equity (Tables)

Shareholders' equity (Tables)	12 Months Ended
	Dec. 31, 2017
Stockholders Equity Note [Abstract]
Components of Changes in Accumulated Other Comprehensive Income (Loss)	The components of and changes in accumulated other comprehensive income (loss) are as follows: (U.S. Dollars, in thousands) Currency Translation Adjustments Derivatives Debt Security Accumulated Other Comprehensive Income (Loss) Balance at December 31, 2015 $ (4,389 ) $ 228 $ (2,071 ) $ (6,232 ) Other comprehensive loss (726 ) (360 ) (1,744 ) (2,830 ) Income taxes — 132 659 791 Reclassification adjustments to: Other expense, net — — 2,727 2,727 Income taxes — — (1,036 ) (1,036 ) Balance at December 31, 2016 $ (5,115 ) $ — $ (1,465 ) $ (6,580 ) Other comprehensive income 4,552 — 3,830 8,382 Income taxes — — (1,475 ) (1,475 ) Reclassification adjustments to: Other expense, net — — 5,585 5,585 Income taxes — — (2,125 ) (2,125 ) Balance at December 31, 2017 $ (563 ) $ — $ 4,350 $ 3,787

Revenue recognition and accou36

Revenue recognition and accounts receivable (Tables)	12 Months Ended
	Dec. 31, 2017
Revenue Recognition And Accounts Receivable [Abstract]
Schedule of Net Sales	The table below presents net sales, which includes product sales and marketing service fees, for each of the years ended December 31, 2017, 2016, and 2015. For the year ended December 31, (U.S. Dollars, in thousands) 2017 2016 2015 Product sales $ 373,538 $ 355,652 $ 341,084 Marketing service fees 60,285 54,136 55,405 Net sales $ 433,823 $ 409,788 $ 396,489

Business segment information (T

Business segment information (Tables)	12 Months Ended
	Dec. 31, 2017
Segment Reporting [Abstract]
Schedule of Net Sales by Reporting Segment	The table below presents net sales by reporting segment: Year Ended December 31, 2017 2016 2015 (U.S. Dollars, in thousands) Net Sales Percent of Total Net Sales Net Sales Percent of Total Net Sales Net Sales Percent of Total Net Sales BioStim $ 185,900 42.9 % $ 176,561 43.1 % $ 164,955 41.6 % Extremity Fixation 103,242 23.8 % 102,683 25.1 % 96,034 24.2 % Spine Fixation 81,957 18.9 % 72,632 17.7 % 75,668 19.1 % Biologics 62,724 14.4 % 57,912 14.1 % 59,832 15.1 % Net sales $ 433,823 100.0 % $ 409,788 100.0 % $ 396,489 100.0 %
Summary of Non-GAAP Net Margin by Reporting Segment	The following table presents Non-GAAP net margin, and internal metric that the Company defines as gross profit less sales and marketing expense, by reporting segment: Year Ended December 31, (U.S. Dollars, in thousands) 2017 2016 2015 BioStim $ 77,369 $ 75,469 $ 67,878 Extremity Fixation 31,071 30,526 29,493 Spine Fixation 8,730 8,650 8,547 Biologics 25,692 26,891 27,226 Corporate (446 ) (888 ) (1,260 ) Non-GAAP net margin $ 142,416 $ 140,648 $ 131,884 General and administrative 74,388 74,404 87,157 Research and development 29,700 28,803 26,389 SEC / FCPA matters and related costs (2,483 ) 2,005 9,083 Charges related to U.S. Government resolutions — 14,369 — Operating income $ 40,811 $ 21,067 $ 9,255 Interest income (expense), net (416 ) 763 (489 ) Other expense, net (4,004 ) (2,806 ) (259 ) Income before income taxes $ 36,391 $ 19,024 $ 8,507
Schedule of Depreciation and Amortization by Reporting Segment	The following table presents depreciation and amortization by reporting segment: Year Ended December 31, (U.S. Dollars, in thousands) 2017 2016 2015 BioStim $ 2,133 $ 2,754 $ 2,933 Extremity Fixation 6,040 5,742 6,636 Spine Fixation 6,949 8,118 10,050 Biologics 752 1,011 1,157 Corporate 4,250 3,216 147 Total $ 20,124 $ 20,841 $ 20,923
Summary of Net Sales by Geographic Destination	The following data includes net sales by geographic destination: (U.S. Dollars, in thousands) 2017 2016 2015 U.S. $ 345,145 $ 316,873 $ 305,505 Italy 17,059 16,664 15,655 United Kingdom 8,725 10,362 11,376 Brazil 10,356 11,334 13,512 Others 52,538 54,555 50,441 Net sales $ 433,823 $ 409,788 $ 396,489
Summary of Property, Plant and Equipment of Reporting Segments by Geographic Area	The following data includes property, plant and equipment by geographic area: (U.S. Dollars, in thousands) 2017 2016 U.S. $ 34,008 $ 38,398 Italy 7,658 7,013 United Kingdom 382 617 Brazil 475 769 Others 2,616 2,119 Total $ 45,139 $ 48,916

Share-based compensation (Table

Share-based compensation (Tables)	12 Months Ended
	Dec. 31, 2017
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Schedule of Share-Based Compensation by Line Item in Consolidated Statements of Operations	The following tables present the detail of share-based compensation by line item in the consolidated statements of operations as well as by award type, for the years ended December 31, 2017, 2016 and 2015: Year Ended December 31, (U.S. Dollars, in thousands) 2017 2016 2015 Cost of sales $ 486 $ 553 $ 440 Sales and marketing 1,471 1,230 1,304 General and administrative 9,671 13,132 5,051 Research and development 929 1,051 419 Total $ 12,557 $ 15,966 $ 7,214 Year Ended December 31, (U.S. Dollars, in thousands) 2017 2016 2015 Stock options $ 2,388 $ 2,021 $ 1,437 Time-based restricted stock awards 5,540 6,016 4,606 Performance-based restricted stock awards 462 5,716 — Performance-based and market-based restricted stock units 2,904 948 — Stock purchase plan 1,263 1,265 1,171 Total $ 12,557 $ 15,966 $ 7,214
Schedule of Assumptions Used in Determining Fair Value of Stock Options	A summary of the Company’s assumptions used in determining the fair value of the stock options granted during the year is shown in the following table. Year Ended December 31, Assumptions: 2017 2016 2015 Expected term (in years) 4.5 4.5 4.5 Expected volatility 31.2 % 30.6% – 32.3% 31.1% – 31.6% Risk free interest rate 1.93 % 1.07% – 1.92% 1.37% – 1.54% Dividend yield — — — Weighted average grant date fair value $ 13.32 $ 11.79 $ 9.49
Schedule of Stock Option Plans	Summaries of the status of the Company’s stock option plans as of December 31, 2017 and 2016 and changes during the year ended December 31, 2017 are presented below: Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term Outstanding at December 31, 2016 1,137,179 $ 36.05 Granted 165,595 $ 46.10 Exercised (152,027 ) $ 34.14 Forfeited (63,925 ) $ 42.50 Outstanding at December 31, 2017 1,086,822 $ 37.47 7.06 Vested and expected to vest at December 31, 2017 1,086,822 $ 37.47 7.06 Exercisable at December 31, 2017 608,320 $ 34.33 5.94
Schedule of Stock Options Outstanding and Exercisable by Exercise Price Range	The table below summarizes the options outstanding and exercisable by exercise price range as of December 31, 2017: Options Outstanding Options Exercisable Range of Exercise Prices Number Outstanding Weighted Average Remaining Contractual Life Weighted Average Exercise Price Number Exercisable Weighted Average Exercise Price $21.78 – $27.97 111,874 5.08 $ 24.12 111,874 $ 24.12 $27.98 – $32.28 110,400 5.36 $ 31.12 91,326 $ 30.90 $33.12 – $33.12 140,475 7.50 $ 33.12 70,242 $ 33.12 $33.24 – $36.25 121,875 6.74 $ 35.51 83,213 $ 35.71 $36.46 – $38.40 39,750 8.55 $ 37.92 12,376 $ 37.64 $38.82 – $38.82 150,000 5.20 $ 38.82 150,000 $ 38.82 $39.66 – $41.37 65,500 6.12 $ 40.23 43,000 $ 40.25 $42.89 – $42.89 22,000 8.74 $ 42.89 5,500 $ 42.89 $44.39 – $44.39 163,138 8.50 $ 44.39 40,789 $ 44.39 $46.10 – $46.10 161,810 9.50 $ 46.10 — $ — $21.78 – $46.10 1,086,822 7.06 $ 37.47 608,320 $ 34.33
Schedule of Changes in Restricted Stock and Stock Units	A summary of the status of our restricted stock and stock units as of December 31, 2017 and 2016 and changes during the year ended December 31, 2017 are presented below: Time-based Awards and Units Performance-based Awards Performance-based or Market-based Stock Units Shares Weighted Average Grant Date Fair Value Shares Weighted Average Grant Date Fair Value Shares Weighted Average Grant Date Fair Value Non-vested as of December 31, 2016 358,919 $ 38.27 192,310 $ 34.45 151,575 $ 43.54 Granted 143,469 $ 46.42 — $ — 94,902 $ 54.49 Vested (157,807 ) $ 37.04 (136,980 ) $ 34.99 — $ — Cancelled (18,707 ) $ 38.59 — $ — (4,613 ) $ 49.09 Non-vested as of December 31, 2017 325,874 $ 42.44 55,330 $ 33.12 241,864 $ 47.73

Income taxes (Tables)

Income taxes (Tables)	12 Months Ended
	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Schedule of Income (Loss) from Continuing Operations Before Provision for Income Taxes	Income (loss) from continuing operations before provision for income taxes consisted of the following: Year Ended December 31, (U.S. Dollars, in thousands) 2017 2016 2015 U.S. $ 27,774 $ 23,006 $ 15,480 Non-U.S. 8,617 (3,982 ) (6,973 ) Income before income taxes $ 36,391 $ 19,024 $ 8,507
Schedule of Provision for Income Taxes on Continuing Operations	The provision for income taxes on continuing operations consists of the following: Year Ended December 31, (U.S. Dollars, in thousands) 2017 2016 2015 U.S. Current $ 3,620 $ 558 $ 6,792 Deferred 20,222 9,296 (1,146 ) 23,842 9,854 5,646 Non-U.S. Current 4,062 4,509 3,661 Deferred 1,196 1,164 1,542 5,258 5,673 5,203 Income tax expense $ 29,100 $ 15,527 $ 10,849
Schedule of Effective Income Tax Rate Reconciliation for Continuing Operations	The rate reconciliation for continuing operations presented below is based on the U.S. federal income tax rate, rather than the Company’s country of domicile tax rate. The Company believes, given the large proportion of taxable income earned in the United States, such disclosure is more meaningful. 2017 2016 2015 (U.S. Dollars, in thousands, except percentages) Amount Percent Amount Percent Amount Percent Statutory U.S. federal income tax rate $ 12,737 35.0 % $ 6,658 35.0 % $ 2,978 35.0 % State taxes, net of U.S. federal benefit 1,598 4.4 395 2.1 521 6.1 Foreign rate differential, including withholding taxes (3,849 ) (10.6 ) (805 ) (4.2 ) (1,934 ) (22.7 ) Charges related to U.S. Government resolutions — — 2,050 10.8 — — Valuation allowances, net 3,548 9.7 6,149 32.3 10,952 128.7 Change in estimate on compensation expenses — — (2,151 ) (11.3 ) — — Italian subsidiary intangible asset (381 ) (1.0 ) (1,477 ) (7.8 ) (2,076 ) (24.4 ) Change of intention for foreign earnings — — 1,300 6.8 — — Domestic manufacturing deduction (818 ) (2.2 ) — — (469 ) (5.5 ) Unrecognized tax benefits, net of settlements 6,002 16.5 3,049 16.0 406 4.8 Impact of the Tax Act 8,347 22.9 — — — — Other, net 1,916 5.3 359 1.9 471 5.5 Income tax expense/effective rate $ 29,100 80.0 % $ 15,527 81.6 % $ 10,849 127.5 %
Schedule of Deferred Tax Assets and Liabilities	The Company’s deferred tax assets and liabilities are as follows: December 31, (U.S. Dollars, in thousands) 2017 2016 Intangible assets and goodwill $ 2,271 $ 2,628 Inventories and related reserves 11,298 17,665 Deferred revenue and cost of goods sold 6,816 11,263 Other accruals and reserves 2,336 4,066 Accrued compensation 4,054 6,747 Allowance for doubtful accounts 2,617 2,898 Accrued interest — 4,621 Net operating loss carryforwards 42,675 37,930 Other, net 2,369 3,032 74,436 90,850 Valuation allowance (46,271 ) (41,701 ) Deferred tax asset $ 28,165 $ 49,149 Withholding taxes (381 ) (648 ) Property, plant and equipment (4,469 ) (1,176 ) Deferred tax liability (4,850 ) (1,824 ) Net deferred tax assets $ 23,315 $ 47,325
Schedule of Gross Unrecognized Tax Benefits (Excluding Interest and Penalties)	A reconciliation of the gross unrecognized tax benefits (excluding interest and penalties) for the years ended December 31, 2017, 2016, and 2015 follows: (U.S. Dollars, in thousands) 2017 2016 2015 Balance as of January 1, $ 18,384 $ 15,763 $ 15,597 Additions for current year tax positions 787 77 332 Increases (decreases) for prior year tax positions 3,361 2,551 (86 ) Settlements of prior year tax positions — — — Expiration of statutes (10 ) (7 ) (80 ) Balance as of December 31, $ 22,522 $ 18,384 $ 15,763

Earnings per share (EPS) (Table

Earnings per share (EPS) (Tables)	12 Months Ended
	Dec. 31, 2017
Earnings Per Share [Abstract]
Schedule of Reconciliation of Weighted Average Shares Used in the Diluted EPS	The following is a reconciliation of the weighted average shares used in the diluted EPS computations. Year Ended December 31, 2017 2016 2015 Weighted average common shares-basic 18,117,405 18,144,019 18,795,194 Effect of diluted securities: Unexercised stock options and employee stock purchase plan 209,691 161,092 — Unvested time-based restricted stock awards 123,592 138,291 — Unvested performance-based restricted stock awards 48,057 19,759 — Weighted average common shares-diluted 18,498,745 18,463,161 18,795,194

Quarterly financial data (una41

Quarterly financial data (unaudited) (Tables)	12 Months Ended
	Dec. 31, 2017
Quarterly Financial Information Disclosure [Abstract]
Condensed Consolidated Statement of Operations	2017 (U.S. Dollars, in thousands, except per share data) 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Year Net sales $ 102,738 $ 108,942 $ 105,247 $ 116,896 $ 433,823 Cost of sales 22,581 23,177 23,717 23,562 93,037 Gross profit 80,157 85,765 81,530 93,334 340,786 Operating expense 74,238 77,767 72,496 75,474 299,975 Operating income 5,919 7,998 9,034 17,860 40,811 Net income (loss) from continuing operations (2,308 ) 4,735 3,348 1,516 7,291 Net income (loss) $ (2,654 ) $ 3,853 $ 3,456 $ 1,568 $ 6,223 Net income (loss) per common share — basic: Net income (loss) from continuing operations $ (0.13 ) $ 0.26 $ 0.18 $ 0.08 $ 0.40 Net income (loss) $ (0.15 ) $ 0.21 $ 0.19 $ 0.09 $ 0.34 Net income (loss) per common share — diluted: Net income (loss) from continuing operations $ (0.13 ) $ 0.26 $ 0.18 $ 0.08 $ 0.39 Net income (loss) $ (0.15 ) $ 0.21 $ 0.19 $ 0.08 $ 0.34 2016 (U.S. Dollars, in thousands, except per share data) 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Year Net sales $ 98,679 $ 104,075 $ 98,497 $ 108,537 $ 409,788 Cost of sales 22,137 22,516 19,880 23,320 87,853 Gross profit 76,542 81,559 78,617 85,217 321,935 Operating expense 69,467 84,254 69,346 77,801 300,868 Operating income (loss) 7,075 (2,695 ) 9,271 7,416 21,067 Net income (loss) from continuing operations 4,576 (6,346 ) 10,384 (5,117 ) 3,497 Net income (loss) $ 3,840 $ (7,444 ) $ 9,896 $ (3,236 ) $ 3,056 Net income (loss) per common share — basic: Net income (loss) from continuing operations $ 0.25 $ (0.35 ) $ 0.57 $ (0.29 ) $ 0.19 Net income (loss) $ 0.21 $ (0.41 ) $ 0.55 $ (0.18 ) $ 0.17 Net income (loss) per common share — diluted: Net income (loss) from continuing operations $ 0.24 $ (0.35 ) $ 0.56 $ (0.29 ) $ 0.19 Net income (loss) $ 0.20 $ (0.41 ) $ 0.54 $ (0.18 ) $ 0.17

Business and Basis of Consoli42

Business and Basis of Consolidation- Additional Information (Detail)	12 Months Ended
	Dec. 31, 2017Segment
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Number Of Reporting Units	4

Significant Accounting Polici43

Significant Accounting Policies - Additional Information (Detail)	Jan. 01, 2018USD ($)	Dec. 31, 2017USD ($)	Sep. 30, 2017USD ($)	Jun. 30, 2017USD ($)	Mar. 31, 2017USD ($)	Dec. 31, 2016USD ($)	Sep. 30, 2016USD ($)	Jun. 30, 2016USD ($)	Mar. 31, 2016USD ($)	Dec. 31, 2017USD ($)Asset	Dec. 31, 2017USD ($)	Dec. 31, 2016USD ($)	Dec. 31, 2015USD ($)
Summary Of Significant Accounting Policies [Line Items]
Net sales		$ 116,896,000	$ 105,247,000	$ 108,942,000	$ 102,738,000	$ 108,537,000	$ 98,497,000	$ 104,075,000	$ 98,679,000		$ 433,823,000	$ 409,788,000	$ 396,489,000
Cumulative-effect adjustment to retained earnings												604,000
Number of assets transferred | Asset										2
Prepaid income taxes										$ 8,600,000
Increase (decrease) in net cash from operating activities											53,341,000	44,707,000	43,610,000
ASU 2014-09 [Member]
Summary Of Significant Accounting Policies [Line Items]
Cumulative-effect adjustment to retained earnings	$ 5,000,000
ASU 2016-16, as Amended [Member] | Subsequent Event
Summary Of Significant Accounting Policies [Line Items]
Cumulative-effect adjustment to retained earnings	$ 2,100,000
ASU 2016-18 [Member]
Summary Of Significant Accounting Policies [Line Items]
Increase (decrease) in net cash from operating activities											(14,400,000)	14,400,000
Musculoskeletal Transplant Foundation ("MTF") [Member]
Summary Of Significant Accounting Policies [Line Items]
Expenditures for other research and development											900,000	1,300,000	0
Customers and Distributors Based in Europe [Member]
Summary Of Significant Accounting Policies [Line Items]
Net sales											57,000,000
Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Transactional foreign currency gains and (losses), including those generated from intercompany operations											$ 1,900,000	$ (100,000)	$ (3,500,000)

Inventories - Schedule of Inven

Inventories - Schedule of Inventories (Detail) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Inventory Disclosure [Abstract]
Raw materials	$ 6,067	$ 7,978
Work-in-process	12,487	9,505
Finished products	11,244	15,985
Field inventory	40,262	22,021
Consignment inventory	8,935	4,428
Deferred cost of sales	2,335	3,429
Inventories	$ 81,330	$ 63,346

Property, Plant and Equipment -

Property, Plant and Equipment - Schedule of Useful Lives of the Assets (Detail)	12 Months Ended
	Dec. 31, 2017
Minimum [Member] | Buildings [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	25 years
Minimum [Member] | Plant and equipment [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	1 year
Minimum [Member] | Instrumentation [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	3 years
Minimum [Member] | Computer software [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	3 years
Minimum [Member] | Furniture and fixtures [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	4 years
Maximum [Member] | Buildings [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	33 years
Maximum [Member] | Plant and equipment [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	10 years
Maximum [Member] | Instrumentation [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	4 years
Maximum [Member] | Computer software [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	7 years
Maximum [Member] | Furniture and fixtures [Member]
Property Plant And Equipment [Line Items]
Useful life, in years	8 years

Property, Plant and Equipment46

Property, Plant and Equipment - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Property Plant And Equipment Useful Life And Values [Abstract]
Depreciation expense	$ 18.3	$ 19	$ 19.2

Property, Plant and Equipment47

Property, Plant and Equipment - Schedule of Property, Plant and Equipment (Detail) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Property Plant And Equipment [Line Items]
Cost	$ 184,109	$ 173,867
Accumulated depreciation	(138,970)	(124,951)
Property, plant and equipment, net	45,139	48,916
Buildings [Member]
Property Plant And Equipment [Line Items]
Cost	3,725	3,225
Plant and equipment [Member]
Property Plant And Equipment [Line Items]
Cost	47,588	43,745
Instrumentation [Member]
Property Plant And Equipment [Line Items]
Cost	75,818	71,962
Furniture and fixtures [Member]
Property Plant And Equipment [Line Items]
Cost	7,605	8,308
Computer software [Member]
Property Plant And Equipment [Line Items]
Cost	48,604	44,720
Construction in progress [Member]
Property Plant And Equipment [Line Items]
Cost	$ 769	$ 1,907

Patents and Other Intangible 48

Patents and Other Intangible Assets - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Finite And Indefinite Lived Intangible Assets [Line Items]
Amortization of intangible assets	$ 1.8	$ 1.8	$ 1.7
Developed Technology [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Weighted average amortization period ( in years)	11 years

Patents and Other Intangible 49

Patents and Other Intangible Assets - Schedule of Patents and Other Intangibles Assets (Detail) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	$ 49,430	$ 46,278
Accumulated amortization	(38,969)	(38,817)
Patents and other intangible assets, net	10,461	7,461
Patents [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	38,621	38,348
Accumulated amortization	(34,151)	(34,717)
Trademarks-finite lived [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	533	319
Accumulated amortization	(193)	(138)
Licenses and other [Member]
Finite And Indefinite Lived Intangible Assets [Line Items]
Cost	10,276	7,611
Accumulated amortization	$ (4,625)	$ (3,962)

Patents and Other Intangible 50

Patents and Other Intangible Assets - Schedule of Future Amortization Expense (Detail) $ in Thousands	Dec. 31, 2017USD ($)
Goodwill And Intangible Assets Disclosure [Abstract]
2,018	$ 2,352
2,019	1,909
2,020	1,366
2,021	1,321
2,022	1,314
Thereafter	2,199
Total future amortization expense	$ 10,461

Goodwill - Schedule of Net Carr

Goodwill - Schedule of Net Carrying Amount of Goodwill (Detail) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Goodwill [Line Items]
Goodwill	$ 53,565	$ 53,565
BioStim [Member]
Goodwill [Line Items]
Goodwill	42,678	42,678
Biologics [Member]
Goodwill [Line Items]
Goodwill	$ 10,887	$ 10,887

Long-term Investments - Additio

Long-term Investments - Additional Information (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	Mar. 04, 2015	Mar. 31, 2017	Dec. 31, 2017	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Debt Instrument [Line Items]
Fair value of the debt security		$ 9,000	$ 16,100	$ 16,100
Unrealized gain (loss) on debt securities				3,830	$ (1,744)	$ (3,348)
Amortized cost basis in debt security			9,000	9,000
Other-than-temporary impairment on debt securities		5,600		5,585	$ 2,727
Bone Biologics Inc [Member]
Investments Equity Securities [Abstract]
Value of common stock held			$ 2,500	$ 2,500
Warrants held for share purchases			458	458
Weighted average exercise price of warrant			$ 1.18	$ 1.18
Warrants exercisable period				7 years
Warrant expiration term				between 2020 and 2021
Warrants expiration start year				2,020
Warrants expiration end year				2,021
eNeura Note [Member] | eNeura Inc [Member]
Debt Instrument [Line Items]
Non-refundable fees paid	$ 300
Accrued interest rate on promissory note	8.00%
Maturity description of Promissory note				The eNeura Note will mature on March 4, 2019
Debt Instrument, Maturity Date				Mar. 4, 2019
eNeura Note [Member] | eNeura Inc [Member] | Convertible Debt Securities
Debt Instrument [Line Items]
Principal amount of promissory note	$ 15,000
eNeura Note [Member] | eNeura Inc [Member] | Debt Securities [Member]
Debt Instrument [Line Items]
Unrealized gain (loss) on debt securities		$ (3,200)	$ 7,100
eNeura Note [Member] | eNeura Inc [Member] | Preferred Stock [Member]
Debt Instrument [Line Items]
Conversion price per share			$ 7.30	$ 7.30
eNeura Note [Member] | eNeura Inc [Member] | Minimum [Member]
Debt Instrument [Line Items]
Third party acquisition			50.00%	50.00%

Other Current Liabilities - Sum

Other Current Liabilities - Summary of Other Current Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Payables And Accruals [Abstract]
Accrued expenses	$ 6,984	$ 6,155
Salaries, bonuses, commissions and related taxes payable	24,635	19,636
Accrued distributor commissions	9,192	9,379
Accrued legal and settlement expenses	7,673	23,081
Non-income taxes payable	3,180	7,301
Other payables	9,631	3,536
Other current liabilities	$ 61,295	$ 69,088

Other Current Liabilities - Add

Other Current Liabilities - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Extremity Fixation Restructuring Plan [Member]
Other Current Liabilities [Line Items]
Pre-tax restructuring expense	$ 3.3
Cumulative costs incurred to date on restructuring	3.3
Accrued in other current liabilities related to restructuring	0.7	$ 1.5
Restructuring costs incurred	1.3
Payments for restructuring	2.1
U.S. Restructuring Plan [Member]
Other Current Liabilities [Line Items]
Accrued in other current liabilities related to restructuring	1.1
Payments for restructuring	0.6
U.S. Restructuring Plan [Member] | Operating Expense [Member]
Other Current Liabilities [Line Items]
Pre-tax restructuring expense	$ 1.7

Long-Term Debt - Additional Inf

Long-Term Debt - Additional Information (Detail)	Aug. 31, 2015USD ($)	Aug. 30, 2015USD ($)	Dec. 31, 2017USD ($)	Dec. 31, 2016USD ($)	Dec. 31, 2015USD ($)	Dec. 31, 2017EUR (€)
Debt Instrument [Line Items]
Maximum borrowing capacity			$ 7,000,000	$ 6,100,000		€ 5,800,000
Debt issuance costs incurred			$ 445,000		$ 1,825,000
2015 Credit Agreement [Member]
Debt Instrument [Line Items]
Credit agreement maturity date			Aug. 31, 2020
Amount outstanding under lines of credit			$ 0
2015 Credit Agreement [Member] | Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Debt instrument term (in years)			5 years
Maximum borrowing capacity	$ 125,000,000
Maximum borrowing capacity available for issuance of letters of credit	25,000,000
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		$ 1,800,000
Debt issuance costs, net of accumulated amortization			$ 1,000,000	1,300,000
Debt issuance costs amortized or expensed			$ 1,000,000	$ 400,000	$ 600,000
2015 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%
2015 Credit Agreement [Member] | Revolving Credit Facility [Member] | Maximum [Member] | LIBOR [Member]
Debt Instrument [Line Items]
Margin on variable rate	2.50%
2015 Credit Agreement [Member] | Revolving Credit Facility [Member] | Maximum [Member] | Base Rate [Member]
Debt Instrument [Line Items]
Margin on variable rate	1.50%
2015 Credit Agreement [Member] | Revolving Credit Facility [Member] | Minimum [Member]
Debt Instrument [Line Items]
Line of credit facility, unused commitment fee percentage	0.25%
2015 Credit Agreement [Member] | Revolving Credit Facility [Member] | Minimum [Member] | LIBOR [Member]
Debt Instrument [Line Items]
Margin on variable rate	1.75%
2015 Credit Agreement [Member] | Revolving Credit Facility [Member] | Minimum [Member] | Base Rate [Member]
Debt Instrument [Line Items]
Margin on variable rate	0.75%

Fair Value Measurements - Sched

Fair Value Measurements - Schedule of Financial Assets and Liabilities Recorded at Fair Value on Recurring Basis (Detail) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Fair Value, Inputs, Level 3 [Member] | Debt Security [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 16,050	$ 12,220	$ 12,658
Fair Value, Measurements, Recurring [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	16,706	14,739
Deferred compensation plan, Liabilities	(1,379)	(1,452)
Liabilities fair value, Total	(1,379)	(1,452)
Fair Value, Measurements, Recurring [Member] | Collective Trust Funds [Member] | Other Noncurrent Assets [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	100	1,584
Fair Value, Measurements, Recurring [Member] | Treasury Securities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	556	467
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		468
Fair Value, Measurements, Recurring [Member] | Debt Security [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	16,050	12,220
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	556	935
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	556	467
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		468
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	100	1,584
Deferred compensation plan, Liabilities	(1,379)	(1,452)
Liabilities fair value, Total	(1,379)	(1,452)
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Collective Trust Funds [Member] | Other Noncurrent Assets [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	100	1,584
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	16,050	12,220
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member] | Debt Security [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets fair value	$ 16,050	$ 12,220

Fair Value Measurements - Addit

Fair Value Measurements - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2017	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Unrealized gain on debt securities		$ 3,830	$ (1,744)	$ (3,348)
Other-than-temporary impairment on debt securities	$ 5,600	5,585	2,727
Debt Securities [Member] | Fair Value, Inputs, Level 3 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Fair value of debt securities		$ 16,050	$ 12,220	$ 12,658

Fair Value Measurements - Sch58

Fair Value Measurements - Schedule of Reconciliation of Debt Securities (Detail) - Debt Securities [Member] - Fair Value, Inputs, Level 3 [Member] - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Fair Value Assets Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Beginning balance	$ 12,220	$ 12,658
Accrued interest income		1,306
Gains or losses recorded for the period
Recognized in net income	(5,585)	(2,727)
Recognized in other comprehensive income	9,415	983
Ending balance	$ 16,050	$ 12,220

Commitments - Additional Inform

Commitments - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Commitments And Contingencies Disclosure [Abstract]
Rent expenses	$ 3.1	$ 3	$ 3
Inventory purchase commitments with third-party	$ 1.9	$ 1.2

Commitments - Schedule of Futur

Commitments - Schedule of Future Minimum Lease Payments Under Operating Leases (Detail) $ in Thousands	Dec. 31, 2017USD ($)
Operating Leases, Future Minimum Payments Due, Fiscal Year Maturity [Abstract]
2,018	$ 3,017
2,019	2,018
2,020	1,240
2,021	1,575
2,022	1,600
Thereafter	12,156
Total	$ 21,606

Contingencies - Additional Info

Contingencies - Additional Information (Detail) - USD ($) $ in Millions	1 Months Ended	3 Months Ended	12 Months Ended
	Jan. 31, 2017	Dec. 31, 2017	Dec. 31, 2017
Commitments And Contingencies Disclosure [Abstract]
Contingencies, settlement agreement, terms			In January 2017, the U.S. Securities and Exchange Commission (the “SEC”) approved the Company’s offers of settlement in connection with the SEC’s investigations of accounting matters leading to the Company’s prior restatement of financial statements and the Company’s review of improper payments with respect to its subsidiary in Brazil. Both investigations were initiated in 2013 and involved matters self-reported to the SEC by the Company. The settlements approved by the SEC resolved these two matters, and included payments totaling $14.4 million by the Company to the SEC of amounts previously accrued and funded into escrow by the Company during 2016. In connection with the Brazil-related settlement, the Company agreed to retain an independent compliance consultant for one year to review and test the Company’s compliance program related to the U.S. Foreign Corrupt Practices Act. The Company’s engagement with its independent compliance consultant began in March 2017. In addition, in the fourth quarter of 2017 the Company received a favorable insurance settlement of approximately $6 million associated with prior costs incurred related to these matters, which the Company has recognized within the in SEC / FCPA matters and related costs line of the consolidated statement of operations and comprehensive income (loss).
Payments for SEC settlements	$ 14.4
Insurance settlements received		$ 6
Discontinued operations for compensatory damages and exemplary damages		$ 1.7	$ 1.7

Shareholders' Equity - Addition

Shareholders' Equity - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2016	Dec. 31, 2015	Dec. 31, 2017
Stockholders Equity Note [Abstract]
Share repurchase program, authorized amount			$ 75,000,000
Common stock repurchased, shares	1,544,681
Common stock repurchased, amount	$ 63,425,000	$ 11,575,000
Common stock repurchased, price per share	$ 41.06

Shareholders' Equity - Componen

Shareholders' Equity - Components of Changes in Accumulated Other Comprehensive Income (Loss) (Detail) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2017	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	$ 263,477	$ 263,477	$ 290,311	$ 299,627
Other comprehensive income (loss)		8,382	(2,830)
Income taxes		(1,475)	791
Other expense, net	5,600	5,585	2,727
Income taxes		29,100	15,527	10,849
Ending Balance		296,608	263,477	290,311
Reclassification Adjustments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Other expense, net		5,585	2,727
Income taxes		(2,125)	(1,036)
Currency Translation Adjustments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	(5,115)	(5,115)	(4,389)
Other comprehensive income (loss)		4,552	(726)
Ending Balance		(563)	(5,115)	(4,389)
Derivatives [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance			228
Other comprehensive income (loss)			(360)
Income taxes			132
Ending Balance				228
Debt Securities [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	(1,465)	(1,465)	(2,071)
Other comprehensive income (loss)		3,830	(1,744)
Income taxes		(1,475)	659
Ending Balance		4,350	(1,465)	(2,071)
Debt Securities [Member] | Reclassification Adjustments [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Other expense, net		5,585	2,727
Income taxes		(2,125)	(1,036)
Accumulated Other Comprehensive Income (Loss) [Member]
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning Balance	$ (6,580)	(6,580)	(6,232)	(382)
Ending Balance		$ 3,787	$ (6,580)	$ (6,232)

Revenue Recognition and Accou64

Revenue Recognition and Accounts Receivable - Schedule of Net Sales (Detail) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2016	Sep. 30, 2016	Jun. 30, 2016	Mar. 31, 2016	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Revenue Recognition And Accounts Receivable [Abstract]
Product sales									$ 373,538	$ 355,652	$ 341,084
Marketing service fees									60,285	54,136	55,405
Net sales	$ 116,896	$ 105,247	$ 108,942	$ 102,738	$ 108,537	$ 98,497	$ 104,075	$ 98,679	$ 433,823	$ 409,788	$ 396,489

Revenue Recognition and Accou65

Revenue Recognition and Accounts Receivable - Additional Information (Detail) $ in Thousands, € in Millions	12 Months Ended
	Dec. 31, 2017USD ($)	Dec. 31, 2017EUR (€)	Dec. 31, 2016USD ($)	Dec. 31, 2016EUR (€)	Dec. 31, 2015USD ($)	Dec. 31, 2015EUR (€)
Health Care Organization Receivable and Revenue Disclosures [Line Items]
Shipping and handling costs	$ 3,000		$ 2,000		$ 2,200
Marketing service fees	60,285		54,136		55,405
Sale of receivables	11,200	€ 9.8	11,100	€ 10	11,900	€ 10.9
Estimated related fee	300		$ 400		$ 500
Biologics [Member]
Health Care Organization Receivable and Revenue Disclosures [Line Items]
Marketing service fees	$ 60,285
Marketing service fee as percentage of segment revenues	96.00%	96.00%

Business Segment Information -

Business Segment Information - Additional Information (Detail)	12 Months Ended
	Dec. 31, 2017Segment
Segment Reporting [Abstract]
Number of strategic business units	4

Business Segment Information 67

Business Segment Information - Schedule of Net Sales by Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2016	Sep. 30, 2016	Jun. 30, 2016	Mar. 31, 2016	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Segment Reporting Information [Line Items]
Net Sales	$ 116,896	$ 105,247	$ 108,942	$ 102,738	$ 108,537	$ 98,497	$ 104,075	$ 98,679	$ 433,823	$ 409,788	$ 396,489
Percent of Total Net Sales									100.00%	100.00%	100.00%
BioStim [Member]
Segment Reporting Information [Line Items]
Net Sales									$ 185,900	$ 176,561	$ 164,955
Percent of Total Net Sales									42.90%	43.10%	41.60%
Extremity Fixation [Member]
Segment Reporting Information [Line Items]
Net Sales									$ 103,242	$ 102,683	$ 96,034
Percent of Total Net Sales									23.80%	25.10%	24.20%
Spine Fixation [Member]
Segment Reporting Information [Line Items]
Net Sales									$ 81,957	$ 72,632	$ 75,668
Percent of Total Net Sales									18.90%	17.70%	19.10%
Biologics [Member]
Segment Reporting Information [Line Items]
Net Sales									$ 62,724	$ 57,912	$ 59,832
Percent of Total Net Sales									14.40%	14.10%	15.10%

Business Segment Information 68

Business Segment Information - Summary of Non-GAAP Net Margin by Reporting Segment (Detail) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2016	Sep. 30, 2016	Jun. 30, 2016	Mar. 31, 2016	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Segment Reporting Information [Line Items]
Non-GAAP net margin									$ 142,416	$ 140,648	$ 131,884
General and administrative									74,388	74,404	87,157
Research and development									29,700	28,803	26,389
SEC / FCPA matters and related costs									(2,483)	2,005	9,083
Charges related to U.S. Government resolutions										14,369
Operating income	$ 17,860	$ 9,034	$ 7,998	$ 5,919	$ 7,416	$ 9,271	$ (2,695)	$ 7,075	40,811	21,067	9,255
Interest income (expense), net									(416)	763	(489)
Other expense, net									(4,004)	(2,806)	(259)
Income before income taxes									36,391	19,024	8,507
Operating Segments [Member] | BioStim [Member]
Segment Reporting Information [Line Items]
Non-GAAP net margin									77,369	75,469	67,878
Operating Segments [Member] | Extremity Fixation [Member]
Segment Reporting Information [Line Items]
Non-GAAP net margin									31,071	30,526	29,493
Operating Segments [Member] | Spine Fixation [Member]
Segment Reporting Information [Line Items]
Non-GAAP net margin									8,730	8,650	8,547
Operating Segments [Member] | Biologics [Member]
Segment Reporting Information [Line Items]
Non-GAAP net margin									25,692	26,891	27,226
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Non-GAAP net margin									(446)	(888)	(1,260)
Material Reconciling Items [Member]
Segment Reporting Information [Line Items]
General and administrative									74,388	74,404	87,157
Research and development									29,700	28,803	26,389
SEC / FCPA matters and related costs									$ (2,483)	$ 2,005	$ 9,083

Business Segment Information 69

Business Segment Information - Schedule of Depreciation and Amortization by Reporting Segment (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 20,124	$ 20,841	$ 20,923
Operating Segments [Member] | BioStim [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	2,133	2,754	2,933
Operating Segments [Member] | Extremity Fixation [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	6,040	5,742	6,636
Operating Segments [Member] | Spine Fixation [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	6,949	8,118	10,050
Operating Segments [Member] | Biologics [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	752	1,011	1,157
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 4,250	$ 3,216	$ 147

Business Segment Information 70

Business Segment Information - Summary of Net Sales by Geographic Destination (Detail) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2016	Sep. 30, 2016	Jun. 30, 2016	Mar. 31, 2016	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 116,896	$ 105,247	$ 108,942	$ 102,738	$ 108,537	$ 98,497	$ 104,075	$ 98,679	$ 433,823	$ 409,788	$ 396,489
Domestic Tax Authority [Member] | U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales									345,145	316,873	305,505
Foreign Tax Authority [Member] | Italy [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales									17,059	16,664	15,655
Foreign Tax Authority [Member] | United Kingdom [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales									8,725	10,362	11,376
Foreign Tax Authority [Member] | Brazil [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales									10,356	11,334	13,512
Foreign Tax Authority [Member] | Others [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales									$ 52,538	$ 54,555	$ 50,441

Business Segment Information 71

Business Segment Information - Summary of Property, Plant and Equipment of Reporting Segments by Geographic Area (Detail) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Revenues from External Customers and Long-Lived Assets [Line Items]
Property plant and equipment net	$ 45,139	$ 48,916
U.S. [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property plant and equipment net	34,008	38,398
Italy [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property plant and equipment net	7,658	7,013
United Kingdom [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property plant and equipment net	382	617
Brazil [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property plant and equipment net	475	769
Others [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Property plant and equipment net	$ 2,616	$ 2,119

Share-based Compensation - Addi

Share-based Compensation - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015	Jun. 29, 2004
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Options outstanding	1,086,822	1,137,179
Options exercisable	608,320
Income tax benefit related to expense	$ 3,400,000	$ 4,300,000	$ 1,600,000
Closing stock price	$ 54.70
Share-based compensation	$ 12,557,000	15,966,000	7,214,000
2012 LTIP Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Award Contractual term	10 years
Amount of shares reserved for issuance	3,200,000
Options outstanding	881,322
Options exercisable	402,820
2004 LTIP Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Amount of shares reserved for issuance				3,100,000
Stock Purchase Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Amount of shares reserved for issuance	1,850,000
Maximum percentage of compensation eligible employees to be deducted for purchase of common stock	25.00%
Purchase price of shares equivalent to fair market value	85.00%
Shares issued under stock purchase plan	1,504,445
Stock Purchase Plan [Member] | Minimum [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Percentage of compensation eligible employees to be deducted for purchase of common stock	1.00%
Restricted Stock [Member] | 2012 LTIP Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unvested restricted stock and stock units outstanding	381,204
Performance Stock Units [Member] | 2012 LTIP Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unvested restricted stock and stock units outstanding	241,864
Staff Share Option Plan [Member] | 2004 LTIP Plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Options outstanding	55,500
Unvested restricted stock and stock units outstanding	0
Stock Option [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Service period	4 years
Unamortized compensation expense	$ 2,900,000
Weighted-average period for unamortized compensation cost expected to be recognized	1 year 6 months
Total intrinsic value of options exercised	$ 2,200,000	4,300,000	700,000
Aggregate intrinsic value of options outstanding	18,700,000	3,300,000	8,000,000
Aggregate intrinsic value of options exercisable	12,400,000	2,200,000	4,300,000
Share-based compensation	2,388,000	2,021,000	1,437,000
Time-based Restricted Stock Awards and Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unamortized compensation expense	$ 11,000,000
Weighted-average period for unamortized compensation cost expected to be recognized	2 years 4 months 24 days
Non-vested shares	143,469
Vesting period	4 years
Non-vested shares, vested in period	$ 7,300,000	7,200,000	6,100,000
Aggregate intrinsic value of restricted stock outstanding	17,800,000	$ 13,000,000	$ 14,900,000
Performance-based Restricted Stock Awards [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unamortized compensation expense	$ 400,000
Weighted-average period for unamortized compensation cost expected to be recognized	1 year
Non-vested shares	0	0	110,660
Non-vested shares, vested in period	$ 4,900,000	$ 0	$ 0
Aggregate intrinsic value of restricted stock outstanding	3,000,000	7,000,000	7,600,000
Share-based compensation	462,000	$ 5,716,000	0
Market-based PSUs [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unamortized compensation expense	$ 5,900,000
Weighted-average period for unamortized compensation cost expected to be recognized	2 years
Non-vested shares	94,902	96,245
Aggregate intrinsic value of restricted stock outstanding	$ 10,200,000	$ 3,500,000	0
Share-based compensation	$ 2,904,000	$ 948,000	$ 0
Common stock issued based on performance stock units	1
Percentage of performance to be achieved	100.00%
Market-based PSUs [Member] | July 2017 Grant Date [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Performance period	3 years
Market-based PSUs [Member] | July 2016 Grant Date [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Performance period	3 years
Market-based PSUs [Member] | Minimum [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Percentage of performance to be achieved	50.00%
Market-based PSUs [Member] | Maximum [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Percentage of performance to be achieved	200.00%
Performance-Based PSUs [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Unvested restricted stock and stock units outstanding	55,330	192,310
Unamortized compensation expense	$ 1,800,000
Weighted-average period for unamortized compensation cost expected to be recognized	1 year
Non-vested shares			55,330
Aggregate intrinsic value of restricted stock outstanding	$ 3,000,000	$ 2,000,000	$ 2,200,000
Share-based compensation	$ 0	$ 0	$ 0

Share-based Compensation - Sche

Share-based Compensation - Schedule of Share-Based Compensation by Line Item in Consolidated Statements of Operations (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 12,557,000	$ 15,966,000	$ 7,214,000
Stock options [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	2,388,000	2,021,000	1,437,000
Time-based Restricted Stock Awards [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	5,540,000	6,016,000	4,606,000
Performance-based Restricted Stock Awards [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	462,000	5,716,000	0
Performance-based and Market-based Restricted Stock Units [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	2,904,000	948,000
Stock purchase plan [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	1,263,000	1,265,000	1,171,000
Cost of sales [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	486,000	553,000	440,000
Sales and marketing [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	1,471,000	1,230,000	1,304,000
General and administrative [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	9,671,000	13,132,000	5,051,000
Research and development [Member]
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share based compensation expense	$ 929,000	$ 1,051,000	$ 419,000

Share-based Compensation - Sc74

Share-based Compensation - Schedule of Assumptions Used in Determining Fair Value of Stock Options Granted (Detail) - $ / shares	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Share Based Compensation Arrangement By Share Based Payment Award Fair Value Assumptions And Methodology [Abstract]
Expected term (in years)	4 years 6 months	4 years 6 months	4 years 6 months
Expected volatility	31.20%
Expected volatility, minimum		30.60%	31.10%
Expected volatility, maximum		32.30%	31.60%
Risk free interest rate	1.93%
Risk free interest rate, minimum		1.07%	1.37%
Risk free interest rate, maximum		1.92%	1.54%
Weighted average grant date fair value	$ 13.32	$ 11.79	$ 9.49

Share-based Compensation - Sc75

Share-based Compensation - Schedule of Stock Option Plans (Detail)	12 Months Ended
	Dec. 31, 2017$ / sharesshares
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Outstanding at the beginning of the period (in shares) | shares	1,137,179
Granted | shares	165,595
Exercised | shares	(152,027)
Forfeited | shares	(63,925)
Outstanding at the end of the period (in shares) | shares	1,086,822
Vested and expected to vest | shares	1,086,822
Exercisable (in shares) | shares	608,320
Outstanding at the beginning of the period (in dollars per share) | $ / shares	$ 36.05
Granted | $ / shares	46.10
Exercised | $ / shares	34.14
Forfeited | $ / shares	42.50
Outstanding at the end of the period (in dollars per share) | $ / shares	37.47
Vested and expected to vest | $ / shares	37.47
Exercisable | $ / shares	$ 34.33
Options outstanding, weighted average remaining contractual term	7 years 21 days
Options vested and expected, weighted average remaining contractual term	7 years 21 days
Options exercisable, weighted average remaining contractual term	5 years 11 months 8 days

Share-based Compensation - Sc76

Share-based Compensation - Schedule of Stock Options Outstanding and Exercisable by Exercise Price Range (Detail)	12 Months Ended
	Dec. 31, 2017$ / sharesshares
$21.78 – $27.97 [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise price, low end of range (in dollars per share)	$ 21.78
Exercise price, high end of range (in dollars per share)	$ 27.97
Number outstanding (in shares) | shares	111,874
Weighted Average Remaining Contractual Life of options outstanding (in years)	5 years 29 days
Weighted Average Exercise Price of options outstanding (in dollars per share)	$ 24.12
Number Exercisable (in shares) | shares	111,874
Weighted Average Exercise Price of options exercisable (in dollars per share)	$ 24.12
$27.98 – $32.28 [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise price, low end of range (in dollars per share)	27.98
Exercise price, high end of range (in dollars per share)	$ 32.28
Number outstanding (in shares) | shares	110,400
Weighted Average Remaining Contractual Life of options outstanding (in years)	5 years 4 months 9 days
Weighted Average Exercise Price of options outstanding (in dollars per share)	$ 31.12
Number Exercisable (in shares) | shares	91,326
Weighted Average Exercise Price of options exercisable (in dollars per share)	$ 30.90
$33.12 – $33.12 [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise price, low end of range (in dollars per share)	33.12
Exercise price, high end of range (in dollars per share)	$ 33.12
Number outstanding (in shares) | shares	140,475
Weighted Average Remaining Contractual Life of options outstanding (in years)	7 years 6 months
Weighted Average Exercise Price of options outstanding (in dollars per share)	$ 33.12
Number Exercisable (in shares) | shares	70,242
Weighted Average Exercise Price of options exercisable (in dollars per share)	$ 33.12
$33.24 – $36.25 [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise price, low end of range (in dollars per share)	33.24
Exercise price, high end of range (in dollars per share)	$ 36.25
Number outstanding (in shares) | shares	121,875
Weighted Average Remaining Contractual Life of options outstanding (in years)	6 years 8 months 26 days
Weighted Average Exercise Price of options outstanding (in dollars per share)	$ 35.51
Number Exercisable (in shares) | shares	83,213
Weighted Average Exercise Price of options exercisable (in dollars per share)	$ 35.71
$36.46 – $38.40 [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise price, low end of range (in dollars per share)	36.46
Exercise price, high end of range (in dollars per share)	$ 38.40
Number outstanding (in shares) | shares	39,750
Weighted Average Remaining Contractual Life of options outstanding (in years)	8 years 6 months 18 days
Weighted Average Exercise Price of options outstanding (in dollars per share)	$ 37.92
Number Exercisable (in shares) | shares	12,376
Weighted Average Exercise Price of options exercisable (in dollars per share)	$ 37.64
$38.82 – $38.82 [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise price, low end of range (in dollars per share)	38.82
Exercise price, high end of range (in dollars per share)	$ 38.82
Number outstanding (in shares) | shares	150,000
Weighted Average Remaining Contractual Life of options outstanding (in years)	5 years 2 months 12 days
Weighted Average Exercise Price of options outstanding (in dollars per share)	$ 38.82
Number Exercisable (in shares) | shares	150,000
Weighted Average Exercise Price of options exercisable (in dollars per share)	$ 38.82
$39.66 – $41.37 [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise price, low end of range (in dollars per share)	39.66
Exercise price, high end of range (in dollars per share)	$ 41.37
Number outstanding (in shares) | shares	65,500
Weighted Average Remaining Contractual Life of options outstanding (in years)	6 years 1 month 13 days
Weighted Average Exercise Price of options outstanding (in dollars per share)	$ 40.23
Number Exercisable (in shares) | shares	43,000
Weighted Average Exercise Price of options exercisable (in dollars per share)	$ 40.25
$42.89 – $42.89 [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise price, low end of range (in dollars per share)	42.89
Exercise price, high end of range (in dollars per share)	$ 42.89
Number outstanding (in shares) | shares	22,000
Weighted Average Remaining Contractual Life of options outstanding (in years)	8 years 8 months 26 days
Weighted Average Exercise Price of options outstanding (in dollars per share)	$ 42.89
Number Exercisable (in shares) | shares	5,500
Weighted Average Exercise Price of options exercisable (in dollars per share)	$ 42.89
$44.39 – $44.39 [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise price, low end of range (in dollars per share)	44.39
Exercise price, high end of range (in dollars per share)	$ 44.39
Number outstanding (in shares) | shares	163,138
Weighted Average Remaining Contractual Life of options outstanding (in years)	8 years 6 months
Weighted Average Exercise Price of options outstanding (in dollars per share)	$ 44.39
Number Exercisable (in shares) | shares	40,789
Weighted Average Exercise Price of options exercisable (in dollars per share)	$ 44.39
$46.10 – $46.10 [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise price, low end of range (in dollars per share)	46.10
Exercise price, high end of range (in dollars per share)	$ 46.10
Number outstanding (in shares) | shares	161,810
Weighted Average Remaining Contractual Life of options outstanding (in years)	9 years 6 months
Weighted Average Exercise Price of options outstanding (in dollars per share)	$ 46.10
$21.78 – $46.10 [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise price, low end of range (in dollars per share)	21.78
Exercise price, high end of range (in dollars per share)	$ 46.10
Number outstanding (in shares) | shares	1,086,822
Weighted Average Remaining Contractual Life of options outstanding (in years)	7 years 21 days
Weighted Average Exercise Price of options outstanding (in dollars per share)	$ 37.47
Number Exercisable (in shares) | shares	608,320
Weighted Average Exercise Price of options exercisable (in dollars per share)	$ 34.33

Share-based Compensation - Sc77

Share-based Compensation - Schedule of Changes in Restricted Stock and Stock Units (Detail) - $ / shares	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2015
Time-based Awards and Units [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Non-vested at the beginning of the period (in shares)	358,919
Granted (in shares)	143,469
Vested (in shares)	(157,807)
Cancelled (in shares)	(18,707)
Non-vested at the end of the period (in shares)	325,874
Non-vested at the beginning of period (in dollars per share)	$ 38.27
Granted (in dollars per share)	46.42
Vested (in dollars per share)	37.04
Cancelled (in dollars per share)	38.59
Non-vested at the end of period (in dollars per share)	$ 42.44
Performance-based Awards [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Non-vested at the beginning of the period (in shares)	192,310
Granted (in shares)		55,330
Vested (in shares)	(136,980)
Non-vested at the end of the period (in shares)	55,330
Non-vested at the beginning of period (in dollars per share)	$ 34.45
Vested (in dollars per share)	34.99
Non-vested at the end of period (in dollars per share)	$ 33.12
Performance-based or Market-based Stock Units [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Non-vested at the beginning of the period (in shares)	151,575
Granted (in shares)	94,902
Cancelled (in shares)	(4,613)
Non-vested at the end of the period (in shares)	241,864
Non-vested at the beginning of period (in dollars per share)	$ 43.54
Granted (in dollars per share)	54.49
Cancelled (in dollars per share)	49.09
Non-vested at the end of period (in dollars per share)	$ 47.73

Defined Contribution Plans an78

Defined Contribution Plans and Deferred Compensation - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
National Collective Labor Agreement [Member] | Labor Force Concentration Risk [Member] | Italy [Member]
Defined Contribution Plan Disclosure [Line Items]
Number of employees, percentage	21.50%
Defined Contribution pension plans for International employees [Member]
Defined Contribution Plan Disclosure [Line Items]
Expenses incurred for contribution plans	$ 1,100,000	$ 1,000,000	$ 1,100,000
Deferred Compensation Plan [Member]
Defined Contribution Plan Disclosure [Line Items]
Annual deferred compensation provision for leaving indemnity, as a percentage of total commissions earned	3.50%
Expense for deferred compensation	$ 100,000	100,000	100,000
Deferred compensation payments	200,000	100,000	0
Amount of deferred compensation payable	$ 1,400,000	1,500,000
Orthofix Inc 401(k) Plan [Member]
Defined Contribution Plan Disclosure [Line Items]
Employee contribution limit per calendar year (as a percent of compensation)	15.00%
Employer match of employee contributions of first level of eligible compensation (as a percent)	100.00%
Percentage of eligible compensation, matched by employer, level one	2.00%
Employer match of employee contributions of second level of eligible compensation (as a percent)	50.00%
Percentage of eligible compensation matched by employer, level two	4.00%
401 (k) Plans [Member]
Defined Contribution Plan Disclosure [Line Items]
Expenses incurred for contribution plans	$ 2,000,000	$ 1,900,000	$ 2,000,000

Income Taxes - Schedule of Inco

Income Taxes - Schedule of Income (Loss) from Continuing Operations Before Provision for Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Income Tax Disclosure [Abstract]
U.S.	$ 27,774	$ 23,006	$ 15,480
Non-U.S.	8,617	(3,982)	(6,973)
Income before income taxes	$ 36,391	$ 19,024	$ 8,507

Income Taxes - Schedule of Prov

Income Taxes - Schedule of Provision for Income Taxes on Continuing Operations (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
U.S.
Current	$ 3,620	$ 558	$ 6,792
Deferred	20,222	9,296	(1,146)
Total U.S	23,842	9,854	5,646
Non-U.S.
Current	4,062	4,509	3,661
Deferred	1,196	1,164	1,542
Total Non U.S	5,258	5,673	5,203
Income tax expense	$ 29,100	$ 15,527	$ 10,849

Income Taxes - Schedule of Effe

Income Taxes - Schedule of Effective Income Tax Rate Reconciliation for Continuing Operations (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Income Tax Disclosure [Abstract]
Statutory U.S. federal income tax rate	$ 12,737	$ 6,658	$ 2,978
State taxes, net of U.S. federal benefit	1,598	395	521
Foreign rate differential, including withholding taxes	(3,849)	(805)	(1,934)
Charges related to U.S. Government resolutions		2,050
Valuation allowances, net	3,548	6,149	10,952
Change in estimate on compensation expenses		(2,151)
Italian subsidiary intangible asset	(381)	(1,477)	(2,076)
Change of intention for foreign earnings	0	1,300
Domestic manufacturing deduction	(818)		(469)
Unrecognized tax benefits, net of settlements	6,002	3,049	406
Impact of the Tax Act	8,347
Other, net	1,916	359	471
Income tax expense	$ 29,100	$ 15,527	$ 10,849
Statutory U.S. federal income tax rate	35.00%	35.00%	35.00%
State taxes, net of U.S. federal benefit	4.40%	2.10%	6.10%
Foreign rate differential, including withholding taxes	(10.60%)	(4.20%)	(22.70%)
Charges related to U.S. Government resolutions		10.80%
Valuation allowances, net	9.70%	32.30%	128.70%
Change in estimate on compensation expenses		(11.30%)
Italian subsidiary intangible asset	(1.00%)	(7.80%)	(24.40%)
Change of intention for foreign earnings		6.80%
Domestic manufacturing deduction	(2.20%)		(5.50%)
Unrecognized tax benefits, net of settlements	16.50%	16.00%	4.80%
Impact of the Tax Act	22.90%
Other, net	5.30%	1.90%	5.50%
Income tax expense/effective rate	80.00%	81.60%	127.50%

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Components Of Income Tax Expense Benefit [Line Items]
Corporate income tax rate			35.00%	35.00%	35.00%
Additional income tax expense benefit	$ 8,300
Tax cuts and jobs act of 2017 change in tax rate deferred tax assets and liability expected to reserve in future			$ 8,600
Change of intention for foreign earnings			0	$ 1,300
Tax cuts and jobs act of 2017 change in provisional income tax benefit			300
Change in estimate, increase in net income				$ 2,400
Change in estimate, increase in earnings per share				$ 0.13
Net increase in valuation allowance			4,600
Unremitted foreign earnings	335,700		$ 335,700	$ 372,500
Minimum percentage of income tax benefit			50.00%
Gross unrecognized tax benefit	22,500		$ 22,500	18,400
Interest and penalties on unrecognized tax benefits			2,300	2,100	$ 200
Accrued interest and penalties related to unrecognized tax benefits	5,300		5,300	$ 3,000
Minimum [Member]
Components Of Income Tax Expense Benefit [Line Items]
Decrease in unrecognized tax benefits	2,400		2,400
Maximum [Member]
Components Of Income Tax Expense Benefit [Line Items]
Decrease in unrecognized tax benefits	3,600		3,600
State [Member]
Components Of Income Tax Expense Benefit [Line Items]
Operating loss carry forwards, net of tax	11,600		11,600
Foreign Jurisdictions [Member]
Components Of Income Tax Expense Benefit [Line Items]
Operating loss carry forwards, net of tax	$ 167,300		$ 167,300
Scenario, Forecast [Member]
Components Of Income Tax Expense Benefit [Line Items]
Corporate income tax rate		21.00%

Income Taxes - Schedule of Defe

Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Abstract]
Intangible assets and goodwill	$ 2,271	$ 2,628
Inventories and related reserves	11,298	17,665
Deferred revenue and cost of goods sold	6,816	11,263
Other accruals and reserves	2,336	4,066
Accrued compensation	4,054	6,747
Allowance for doubtful accounts	2,617	2,898
Accrued interest		4,621
Net operating loss carryforwards	42,675	37,930
Other, net	2,369	3,032
Total	74,436	90,850
Valuation allowance	(46,271)	(41,701)
Deferred tax asset	28,165	49,149
Withholding taxes	381	648
Property, plant and equipment	(4,469)	(1,176)
Deferred tax liability	(4,850)	(1,824)
Net deferred tax assets	$ 23,315	$ 47,325

Income Taxes - Schedule of Gros

Income Taxes - Schedule of Gross Unrecognized Tax Benefits (Excluding Interest and Penalties) (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Income Tax Disclosure [Abstract]
Beginning Balance	$ 18,384	$ 15,763	$ 15,597
Additions for current year tax positions	787	77	332
Increases (decreases) for prior year tax positions	3,361	2,551	(86)
Expiration of statutes	(10)	(7)	(80)
Ending Balance	$ 22,522	$ 18,384	$ 15,763

Earnings Per Share (EPS) - Sche

Earnings Per Share (EPS) - Schedule of Reconciliation of Weighted Average Shares Used in the Diluted EPS (Detail) - shares	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Earnings Per Share [Line Items]
Weighted average common shares-basic	18,117,405	18,144,019	18,795,194
Effect of diluted securities:
Weighted average common shares-diluted	18,498,745	18,463,161	18,795,194
Stock Options And Employee Stock Purchase Plan [Member]
Effect of diluted securities:
Effect of diluted securities	209,691	161,092
Time-Based Restricted Stock Awards [Member]
Effect of diluted securities:
Effect of diluted securities	123,592	138,291
Performance-based Restricted Stock Awards [Member]
Effect of diluted securities:
Effect of diluted securities	48,057	19,759

Earnings Per Share (EPS) - Addi

Earnings Per Share (EPS) - Additional Information (Detail) - Stock options [Member] - shares	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Adjustment for common stock equivalents			0
Restricted Stock And Performance Based Equity Awards [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Outstanding awards and options not included in diluted earnings per share	418,859	542,555	1,033,731

Quarterly Financial Data - Cond

Quarterly Financial Data - Condensed Consolidated Statement of Operations (Detail) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2016	Sep. 30, 2016	Jun. 30, 2016	Mar. 31, 2016	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Quarterly Financial Information Disclosure [Abstract]
Net sales	$ 116,896	$ 105,247	$ 108,942	$ 102,738	$ 108,537	$ 98,497	$ 104,075	$ 98,679	$ 433,823	$ 409,788	$ 396,489
Cost of sales	23,562	23,717	23,177	22,581	23,320	19,880	22,516	22,137	93,037	87,853	86,525
Gross profit	93,334	81,530	85,765	80,157	85,217	78,617	81,559	76,542	340,786	321,935	309,964
Operating expense	75,474	72,496	77,767	74,238	77,801	69,346	84,254	69,467	299,975	300,868
Operating income	17,860	9,034	7,998	5,919	7,416	9,271	(2,695)	7,075	40,811	21,067	9,255
Net income (loss) from continuing operations	1,516	3,348	4,735	(2,308)	(5,117)	10,384	(6,346)	4,576	7,291	3,497	(2,342)
Net income (loss)	$ 1,568	$ 3,456	$ 3,853	$ (2,654)	$ (3,236)	$ 9,896	$ (7,444)	$ 3,840	$ 6,223	$ 3,056	$ (2,809)
Net income (loss) per common share—basic
Net income (loss) from continuing operations	$ 0.08	$ 0.18	$ 0.26	$ (0.13)	$ (0.29)	$ 0.57	$ (0.35)	$ 0.25	$ 0.40	$ 0.19	$ (0.12)
Net income (loss)	0.09	0.19	0.21	(0.15)	(0.18)	0.55	(0.41)	0.21	0.34	0.17	(0.15)
Net income (loss) per common share—diluted
Net income (loss) from continuing operations	0.08	0.18	0.26	(0.13)	(0.29)	0.56	(0.35)	0.24	0.39	0.19	(0.12)
Net income (loss)	$ 0.08	$ 0.19	$ 0.21	$ (0.15)	$ (0.18)	$ 0.54	$ (0.41)	$ 0.20	$ 0.34	$ 0.17	$ (0.15)