Despite the ongoing presence of the pandemic, we posted a strong quarter of organic sales growth of 4.7% versus Q1 2019.
These trends give us confidence in achieving our guidance of 8% to 10% full year organic sales growth compared to 2019, which is equivalent to 12% to 14% organic versus 2020, despite one less selling day.
During the quarter, our combined trauma and extremities business showed good resiliency, growing 2.6%, including Wright Medical compared to 2019 despite the ongoing impacts of COVID restrictions during the quarter.
Our organic sales growth was 4.7% in the quarter.
Compared to 2019, pricing in the quarter was unfavorable 1.4%.
Versus Q1 2020, pricing was 0.9%, unfavorable.
Foreign currency had a favorable 1.3% impact on sales.
For the quarter, US organic sales increased by 1%, reflecting the continuing slowdown in elective procedures as a result of the pandemic, somewhat offset by strong demand for Mako, medical products, and neurovascular products.
International organic sales showed strong growth of 15% and impacted by positive sales momentum in China, Japan, Australia, and Canada.
Our adjusted quarterly earnings per share of $1.93 increased 2.7% from 2019, reflecting sales growth partially offset by higher interest charges resulting from the Wright acquisition as well as an overall disciplined ramp-up in operating costs.
Our first quarter earnings per share was positively impacted from foreign currency by $0.03.
Orthopaedics had constant currency sales growth of 17.2%, an organic sales decline of 0.7%, including an organic decline of 1.7% in the US.
Other Ortho grew 49% in the US, primarily reflecting strong demand for our Mako robotic platform, partially offset by declines in bone cement.
Internationally, Orthopaedics grew 1.5% organically, which reflects the COVID-19 related procedural slowdown in hips and knees, especially in Europe, offset by strong performances in Australia and Japan.
For the quarter, our trauma and extremities business, which includes Wright Medical, delivered 2.6% growth on a comparable basis.
In the US, comparable growth was 4.4%.
In the quarter, MedSurg had constant currency and organic sales growth of 5.3%, which included 1.6% growth in the US.
Instruments had a US organic sales decline of 3%, primarily impacted by continued procedural slowdown that impacted its power tool business, partially offset by gains in its waste management, smoke evacuation products, and services business.
As a reminder, during the first quarter of 2019, Instruments had a very strong growth of approximately 18%.
Endoscopy had a US organic sales decline of 5.7%, reflecting a slowdown in some of the capital businesses, which was partially offset by gains in our General Surgery, Video & Sports Medicine businesses, the latter of which grew over 11% in the quarter.
The medical division had US organic sales growth of 13.6%, reflecting double-digit performance in its emergency care and Sage businesses.
Internationally, MedSurg had an organic sales growth of 19.9%, reflecting strong growth across Europe, Canada, Australia and Japan in Medical, Endoscopy and Instruments.
Neurotechnology and spine had constant currency and organic growth of 12.8%.
This growth reflects double-digit performances in our Interventional spine, neurosurgical and ENT businesses and 27% growth in our neurovascular business.
Our US Neurotech business posted an organic growth of 12%, reflecting strong product growth in our neuro powered drills, SonoPet IQ, bipolar forceps, Bio reabsorbs and nasal implants.
Internationally, Neurotechnology and spine had organic growth of 31.7%.
Our adjusted gross margin of 65.4% was unfavorable approximately 40 basis points from our first quarter 2019.
Adjusted R&D spending was 6.8% of sales, reflecting our continued focus on innovation.
Our adjusted SG&A was 35.2% of sales, which was unfavorable to the first quarter of 2019 by 70 basis points.
In summary, for the quarter, our adjusted operating margin was 23.5% of sales, which is 160 basis points decline over the first quarter of 2019.
We also reiterate our operating margin expansion guidance of 30 to 50 basis points improvement over 2019 operating margin, excluding the impact of Wright Medical.
Our first quarter had an adjusted effective tax rate of 13%, given our mix of income.
Given our current circumstances and the outlook for the full year, we would expect to be at the lower end of our range for the full year guided effective tax rate of 15.5% to 16.5%.
Focusing on the balance sheet, we ended the first quarter with $2.3 billion of cash and marketable securities and total debt of $13.1 billion.
During the quarter, we repaid $750 million of maturing debt.
Our year-to-date cash from operations was approximately $450 million.
This performance reflects the results of earnings, continued good management of working capital and approximately $170 million of one number expenditures related to the Wright Medical Integration.
Based on our first quarter performance and the current operating environment, we continue to expect 2021 organic net sales growth to be in the range of 8% to 10%.
If foreign currency exchange rates hold near current levels, we expect net sales in the full year will be positively impacted by approximately 1%.
Net earnings per diluted share will be positively impacted by $0.05 to $0.10 in the full year, and this is included in our revised guidance range.
Based on our first quarter performance and including consideration of our improved full year Wright Medical sales impact, disciplined cost management, and continued positive recovery outlook, we now expect adjusted net earnings per diluted share to be in the range of $9.05 to $9.30.

Summary:
These trends give us confidence in achieving our guidance of 8% to 10% full year organic sales growth compared to 2019, which is equivalent to 12% to 14% organic versus 2020, despite one less selling day.
Our organic sales growth was 4.7% in the quarter.
For the quarter, US organic sales increased by 1%, reflecting the continuing slowdown in elective procedures as a result of the pandemic, somewhat offset by strong demand for Mako, medical products, and neurovascular products.
Our adjusted quarterly earnings per share of $1.93 increased 2.7% from 2019, reflecting sales growth partially offset by higher interest charges resulting from the Wright acquisition as well as an overall disciplined ramp-up in operating costs.
Based on our first quarter performance and the current operating environment, we continue to expect 2021 organic net sales growth to be in the range of 8% to 10%.
If foreign currency exchange rates hold near current levels, we expect net sales in the full year will be positively impacted by approximately 1%.
Based on our first quarter performance and including consideration of our improved full year Wright Medical sales impact, disciplined cost management, and continued positive recovery outlook, we now expect adjusted net earnings per diluted share to be in the range of $9.05 to $9.30.