Orthofix Medical Inc.

Thank you for standing by. At this time, I would like to welcome everyone to the OrthoFix fourth quarter 2025 earnings call. All lines have been placed on mute to prevent any background noise. After the speaker's remarks, there will be a question and answer session. If you'd like to ask a question during this time, simply press star followed by the number one on your telephone keypad. If you would like to withdraw your question, press star one again. We do ask questions be limited to one question and a brief related follow-up. Thank you. I would now like to turn the call over to Julie Dewey.

Thank you, Operator, and good morning, everyone. Welcome to OrthoFix's fourth quarter 2025 earnings call. I'm Julie Dewey, OrthoFix's Chief IR and Communications Officer. Joining me today are President and Chief Executive Officer Massimo Calafiori and Chief Financial Officer Julie Andrews. Today's press release and supplemental presentation are available on the Events and Presentations page in the Investors section of orthofix.com, and a replay of this call will be posted shortly after we conclude. Before we begin, please note that our remarks include forward-looking statements. These statements involve risks and uncertainties, and actual results may differ materially. All statements other than those of historical facts are forward-looking statements. We do not undertake any obligation to revise or update such forward-looking statements. Factors that could cause actual results to differ materially are discussed in our most recent filings with the SEC and may be included in our future filings with the SEC. We'll also reference various non-GAAP financial measures. Reconciliations to U.S. GAAP and additional details are in our press release and supplemental materials. Unless otherwise stated, Net sales growth rates are on a pro forma constant currency basis and exclude the discontinued M6 artificial disk product lines and all results of operations will be on a non-gap as adjusted basis. Here's today's agenda. Massimo will start with business performance and operational highlights. Julie Andrews will follow with our financial results and our 2026 outlook. Then we'll open the call for Q&A. With that, I'll turn the call over to Massimo.

Thank you, Julie, and good morning, everyone. I appreciate you joining us today. The fourth quarter kept a year of meaningful operational progress for OrthoFix. We delivered strong, consistent performance in bone growth therapies and US limb reconstruction. And the work we did to finalize our spine commercial channel supported double-digit net sales growth in our global spine fixation business. This momentum contributed to our eight consecutive quarter of adjusted EBITDA growth and a standout quarter of free cash flow generation. Collectively, these results show the positive impact of our focused commercial initiatives and margin enhancement efforts providing a solid foundation as we enter 2026. Further demonstrating our progress, let me highlight several key accomplishments. Global spine fixation Q4 net sales grew 10% for the year and in Q4. In US, spine fixation, net sales grew 6% for the year and 5% for the quarter. While distributor transition implemented earlier in 2025 created some temporary pressure during the quarter, performance improved meaningfully as we exited Q4. With this transition now largely behind us, variable access to important IDN accounts, and a strengthened, highly aligned distributor network in place, we believe the business is set up well for 2026. Building on that momentum, our spine commercial channel optimization efforts continued to strengthen sales productivity. In Q4, our top 30 US distributor partners grew net sales 25% year-over-year and 27% on a trailing 12-month basis, a clear validation of our focused channel strategy. Turning to enabling technologies, 7D flash navigation continues to be a powerful differentiator across our surgical ecosystem. Voyager earn-out placement grew 30% in 2025, and our earn-out customers are collectively exceeding their purchase commitments by more than 50%, demonstrating strong utilization and engagement. Looking ahead, one of the most exciting milestones for 2026 will be the full market release or our Virada spinal fixation system in the second half of the year. Virada is purpose-built for the $2 billion US pedicle screw market, pairing a proprietary screw design with intuitive instrumentation that integrates seamlessly with the 7D navigation platform. We believe Virada will enhance surgical efficiency, strengthen surgeon confidence, and serve as a multi-year growth catalyst for our U.S. spine business in 2026, 2027, and beyond. Shifting gears, we have rebranded our orthopedics business as a limb reconstruction to reflect our strategic focus on four high-value clinical categories. limb preservation, limb lengthening, complex fracture management, and extremity deformity correction. Together, these represent an estimated $2.6 billion market opportunity, and we believe Orsofix is well positioned given our comprehensive portfolio of internal and external fixation solutions. From our perspective, few companies are prioritizing this market, which give us an opportunity to elevate the care pathway in a category with meaningful long-term growth potential. In 2025, we sharpened our focus on high return opportunities in this business by streamlining our product portfolio strengthening organization alignment, and refining our commercial strategy. These actions draw sustained momentum. U.S. limb reconstruction grew 8% in Q4 and 16% for the full year. This performance was driven by the successful global launch of Truelock Elevate, Fitbon-Bond Transport's and fit bone trochantering lengthening nails, each expanding our addressable market, enhancing our product mix, and fortifying our leadership position as we had in 2026. Turning to bone growth therapy, the BGT business remained a consistent performer, delivering accelerating momentum throughout the year and strong sequential fourth quarter growth that benefited from procedural cross-selling. Fourth quarter growth reached 7%, more than double the market rate, driven by increased utilization and higher prescribing velocity across both spine fusion and fracture management. With its consistent performance and healthy margin, BGT continues to be an important contributor to our overall progress. As we enter 2026, our priorities are clear. Sharpen commercial execution, drive deeper market penetration adoption of our 7D navigation system, improve gross margin through targeted operational initiatives, and maintain targeted capital allocation with a continued focus on adjusted EBITDA expansion and free cash flow generation. With full year contribution from TrueLock Elevate and Fitbon, the planned second half of full commercial launch of Virada, ongoing benefit from our optimization of our spine commercial channel, and renewed focus on advancing our biologics portfolio, and sustained momentum across limb reconstruction and BGT business, we believe the company is well positioned to deliver durable top-line growth, expanding margin, and strong free cash flow in 2026. Today, we also announced that we are recalibrating the timeline for our three-year financial targets to fully capture the anticipated benefits of our spine commercial channel optimization. Over the past year, the decision to optimize our spine commercial channel has proven to be the right one, strengthening our foundation and driving measurable improvement in execution and distributor productivity. At the same time, the scope and rigor of this transformation required us to implement these changes with deliberate care to increase the likelihood of long-term success. As a result, while the underlining fundamentals of our strategy remain strong, the timing of certain growth benefits has shifted, and we are extending our long-range plan timeline by one year to fully capture the expected operational and commercial leverage created by this channel enhancement. This adjustment reflects our commitment to disciplined execution and should position us to deliver sustainable above-market growth and margin expansion as this initiative matures. In closing, 2025 was a year defined by strength and commercial capabilities disciplined execution, and meaningful new product launches from our innovation pipeline. We delivered another year of significant adjusted EBITDA gains and positive free cash for generation, excluding the impact from M6. As we move into 2026, we are carrying that momentum forward with disciplined commercial execution and targeted capital deployment. While our work is not yet complete and certain benefits from our SPAN initiatives are expected to continue to build over time, we are increasingly confident in our ability to execute. We believe the traction behind our strategy and the strength of our innovation engine position us well as we advance towards our long-term financial goals and create sustainable value for our shareholders. Thank you for your continued support. I'll now turn the call over to Julie Andrews.