Doctors discuss medical treatment as they look at an X-Ray image on a monitor in this Reuters file photo. REUTERS/Fabrizio BenschAnother multi-billion dollar international healthcare deal could be coming if Johnson & Johnson has its way. Synthes, a Swiss medical device maker, confirmed it is in takeover talks with J&J after reports the U.S. health giant is keen to buy it for about $20 billion.

What does J&J want from a Swiss company many have never heard of before? The acquisition, which would be J&J’s biggest ever, would give the company a leading edge in equipment used to treat trauma patients. Synthes makes nails, screws and plates to fix broken bones, as well as artificial spine discs.

But a deal is far from certain at this stage. As the WSJ’s Katharina Bart points out, key to any deal is the agreement of Synthes Chairman Hansjoerg Wyss, a “secretive billionaire” who owns 48 percent of the company directly and through family trusts.

In other health deals news, Community Health Systems, a U.S. hospital operator, sweetened its offer for smaller rival Tenet Healthcare by converting its existing $3.3 billion bid to an all-cash proposal. The new offer has changed to $6 a share in cash from $5 a share and $1 in Community Health stock. Tenet’s board of directors is reviewing the new offer.

NYSE Euronext would likely want a hefty financial guarantee from Nasdaq OMX to ensure its takeover bid will make it past antitrust regulators before it’s willing to take part in deal talks, two sources with knowledge of the matter told Reuters correspondents Jonathan Spicer and Paritosh Bansal.