AO / Synthes / J&J / DePuy isn't "bare bones" (unless you're just using k-wires and solid screws).... it's top quality for most things and average to a bit above on cost typically. They just don't market a ton (because their stuff is good, sells itself). They come out with lock plates and stuff first or very soon (ie, watched the failure that was tight rope... developed and now offer fibulink, also have acquired a top staple company and top MIS company).
Other ones aren't "more user friendly" either...
Plates and screws are plates and screws. Synthes has all of the MIS and gimmicky stuff if you want it (Crossroads). Stryker is #2 company... basically knockoffs of synthes with fancy colors. Other ones are varied twists and gimmicks... higher cost typically. They're all based off AO.
What you will need, beyond a screw/plate company, is a soft tissue company (Arthrex is market leader, my choice). You also need a bone grafts/products company for allograft etc (every company has dbm). So, I use synthes screws/plates/staples, arthrex anchors/bioscrews, occasionally mtf for allograft hospital bone bank doesn't have. I typically have Stryker or a different Synthes set as backup since that's what most facilities have (in case main set was dropped /contaminated).
Where companies get a lot of profit is usually their biologics and new stuff. If they get surgeons using them for everything, they can sneak in high margin stuff. Its no wonder Twice medical pays to plant podiatry text chapters or lectures. All companies always send a jock dude or cute lady rep... a lot of docs are dorks who fall for it. Just think about all the marketing and repping and gifts to docs some companies do, and that comes out in price markups.
A lot of ASCs wisely just make them all same cost (akin staple from Synthes or Wmt or Stryker all get $300, 4.0mm cann screws all get $200 each, etc). Many of them blackball the brands / "systems" that are way outliers (tweece etc). Some don't.
...You also have to think about removal. A lot of the 'niche' companies get bought, sold, go out of biz, change/modify reps a lot. Some of them have wacky screwdrivers, stupid stuff that makes revision/salvage rough, and soft metals like titanium strip and break easier. I pick synthes as much for the quality and price as for the fact the patient can get fibula plate or calc screws out anywhere in the world. As mentioned, at physician-owner surgery centers, they magically use almost exclusively synthes wires and solid screws ... yet results are good.
At the end of the day, it's your skill and planning and patient selection/education that makes a surgery go well. Technique over "technology."
