Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-23	Conventional surgical procedures on the midfoot can be done to address a variety of pathologies and/or conditions of a patient’s anatomy. Furthermore, a variety of wedge resections, opening wedge, closing wedge, and the like can be performed to address varus, valgus, dorsiflexion, plantarflexion and other orientation conditions of the foot generally and/or particular bones of the foot. Advantageously, the patient-specific apparatus, methods, and systems of the present disclosure can be implemented based on patient imaging data to address these various conditions. In addition, the medical techniques that incorporate the patient-specific apparatus, methods, and systems of the present disclosure can include certain conventional steps and stages and new stages or steps that are enabled by the present disclosure.	366	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	For example, in certain medial midfoot and/or lateral midfoot surgical procedures a surgeon may prefer to deploy one or more fasteners at a predetermined angle or trajectory into one or more bones of the midfoot prior to making any resection. The surgeon may then use imaging techniques such as fluoroscopy to verify that the fasteners are in the desired position and have the desired trajectory and/or have a desired depth. If the imaging indicates the fasteners are in not a desired position with a desired orientation, a surgeon may re-deploy one or more fasteners and then re-check the position using medical imaging equipment.	367	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	If the imaging confirms the fasteners are in a desired position with a desired orientation, a surgeon may resect one or more bones by moving a cutting tool between and/or along the deployed fasteners. In this manner the fasteners may serve as a stop or guide to prevent resection beyond the position of the fasteners.	368	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Advantageously, the present disclosure can facilitate conventional surgical techniques by using the systems disclosed herein. As explained above, the bone attachment features 724 may be configured to facilitate using fasteners 710 deployed in holes 764 to serve the same purpose as the fasteners used in conventional midfoot surgical procedures. One way this can be accomplished is by having a trajectory for fasteners 710 in the bone attachment feature 724 extend parallel to a trajectory for one or the other or for each of the proximal resection feature 758 and the distal resection feature 762. Alternatively, or in addition, the holes 764 can be angled to have the same trajectory a surgeon desires for the resection of bone, such as a resection of a wedge. In this manner, the fasteners 710 in the holes 764 of the bone attachment features 724 can serve to guide a surgeon to ensure that they do not resect beyond the position of the fasteners 710. Advantageously, the embodiments of the resection guide 720 and/or the preoperative planning of the present disclosure can provide a surgeon with the confidence that resection using the resection features 722 will be as planned that costly intraoperative medical imaging can be avoided. This can save costs for the surgical procedures and time and minimize patient exposure to radiation emitted by the medical imaging equipment.	369	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIG. 14 illustrates a stage of performing a surgical procedure using a lateral approach to form a closing wedge. FIG. 14 illustrates a dorsal perspective view of a foot and ankle including a talus 222, a calcaneus 224, a tibia 226, and a navicular 218. Certain patients may present with midfoot bones having a variety of conditions. Due to age, disease, deformity, or different pathologies, the bones of the midfoot may be deteriorated to the point that individual bones may be challenging to distinguish from each other. FIG. 14 illustrates one such example. The division between the talus 222 and the navicular 218 may be challenging to distinguish. Also, the medial cuneiform 202, intermediate cuneiform 204, and/or lateral cuneiform 206 may be challenging to distinguish from each other.	370	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIG. 14 illustrates one example of a resection guide 1220 coupled to the bones using bone attachment features 724 that include fasteners 710, e.g., K-wires. In one embodiment, a surgeon has formed an incision down to the cortical bone surface with a lateral approach. In the illustrated embodiment, the resection guide 1220 may be configured (e.g., using the bone engagement surface 726) to seat near where the lateral cuneiform 206 contacts the navicular 218. The surgeon has deployed two or more fasteners 710 (e.g., K-wires) through the holes 764 of the bone attachment features 724. The surgeon has also resected the bones to remove a wedge shape that extends from the lateral side of the foot toward the medial side. Here, the two cuts may form two cut surfaces that form a wedge shape of bone that has been removed to perform a midfoot closing wedge osteotomy.	371	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIG. 14B is a close-up view of the same stage illustrated in FIG. 14A. A surgeon may then continue to a surgical procedure to deploy an implant and/or fuse the resected surfaces of the one or more bones. In certain procedures, such as those to address a charcot condition, the resections may extend from the medial side of the foot to the lateral side. Alternatively, or in addition, the resections may cross each other within the foot and form a wedge shape that can be used to address the condition.	372	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	With the resection completed, the resection guide 1220 can be removed and the fasteners 710 used to translate and/or rotate the proximal and distal bone or bone fragments of the midfoot. In one embodiment, a compressor or distractor can be deployed over the fasteners 710 to facilitate joining the cut surfaces and/or fusing the bones.	373	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Those of skill in the art will appreciate that for certain patients with certain pathologies, the form and/or shape of the resection guide 1220 can be different. For example, suppose midfoot bones of a patient have deteriorated such that a larger wedge is to be resected than the example shown in FIG. 14. In such an embodiment, the body 732 of the resection guide 1220 may be longer such that one resection feature is positioned near a distal end of the navicular 218 and another resection feature is positioned on, or near, a base of one or more metatarsals.	374	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	As explained above, the resection guide 1220 can be positioned, sized, configured, and oriented and/or trajectories set for the resection guide 1220 preoperatively using bone models. Additionally, a surgeon can provide a prescription for the location of guide features (e.g., resection features 722) to account for other conditions of a particular patient.	375	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Those of skill in the art will appreciate that the resection guide 1220 can be used for a variety of procedures in a hindfoot, midfoot, forefoot, hand, wrist, elbow, shoulder, and/or the like. One skilled in the art can appreciate that the presented embodiments may be modified, revised, or repositioned to address a surgeon’s particular angles, approach, entry locations and/or preferences.	376	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Advantageously, the present disclosure provides an apparatus, system, and/or method that can remediate a condition in a patient's foot. Those of skill in the art will appreciate that the methods, processes, apparatuses, systems, devices, and/or instruments of the present disclosure can be used to address a variety of conditions in a variety of procedures and/or parts of the body of the patient.	400	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	The resection guide 1620 includes a fourth resection feature 1628 that extends from the medial side 744 to the lateral side 746. The fourth resection feature 1628 is configured to guide a cutting tool to form a fourth osteotomy in at least one midfoot bone (e.g., a medial cuneiform 202). The fourth trajectory 1636 defined, at least in part, by the fourth resection feature 1628 for the fourth osteotomy is determined based on the bone model 404.	393	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Depending on the surgical procedure, the needs of the patient, and/or the condition of the bones and other tissues, for certain corrections and/or conditions, the surgeon may resect from the medial side of the foot to the lateral side of the midfoot. Advantageously, the first trajectory 1630 cooperates with the second trajectory 1632 to form a first bone wedge 1638. The third trajectory 1634 cooperates with the fourth trajectory 1636 to form a second bone wedge 1640. Since the osteotomies may extend through a plurality of bones, the first bone wedge 1638 and/or second bone wedge 1640 can includes a plurality of bone fragments.	394	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	When a surgeon forms a first osteotomy with the first resection feature 1622, the second osteotomy with the second resection feature 1624, the third osteotomy with the third resection feature 1626, and the fourth osteotomy with the fourth resection feature 1628, this creates a remainder bone portion 1642. The remainder bone portion 1642 is one or more bone fragments that remain within the midfoot after completion of the osteotomies (first, second, third, and fourth). The remainder bone portion 1642 is one or more bone fragments that remain within the midfoot when the osteotomies are reduced. In the illustrated embodiment, the remainder bone portion 1642 may include part of the navicular 218, part of the intermediate cuneiform 204, part of the lateral cuneiform 206, and/or part of the cuboid 220. Reducing the osteotomies may sandwich the remainder bone portion 1642 between the second osteotomy and the third osteotomy. Advantageously, the ability to create and retain a remainder bone portion 1642 can be useful for a surgical procedure where the quality and condition of the bones varies. For example, surgeon may design the remainder bone portion 1642 to include bone segments or fragments that are of higher quality or condition to help achieve the goals of the surgical procedure.	395	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	The resection guide 1620 includes a first bone attachment feature 1644 configured to receive a first fastener to secure the resection guide 1620 to the midfoot of the patient. The resection guide 1620 also includes a second bone attachment feature 1646 configured to receive a second fastener to secure the resection guide to the midfoot and a third bone attachment feature 1648 configured to receive a third fastener to secure the resection guide to the midfoot. In the illustrated embodiment, the second bone attachment feature 1646 is between the second resection feature 1624 and the third resection feature 1626.	396	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Using the resection guide 1620 a plurality of wedge segments may be formed using a single resection guide to form two or more wedge segments. Those of skill in the art will appreciate that the resection guide 1620 can be configured, positioned, and secured in a single step and span a plurality of joints for performing multiple osteotomies.	397	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Those of skill in the art will appreciate that embodiments of the system disclosed herein can be used on humans and animals and on bones that are relatively small in comparison to other bones of the body (e.g., bones of the foot and hand). Advantageously, the embodiments of the system seek to minimize the number of fasteners or pins placed within the bones of a patient by planning a surgical procedure such that pins or fasteners placed in one stage are and/or can be reused in subsequent stages. Consequently, pins initially deployed can remain in the bone or bone fragment as instruments are deployed and/or subsequent stages of the surgical procedure are performed.	398	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Advantageously, because the present disclosure uses a bone model of the patient’s bones the sizes, dimensions, lengths and configurations of the components of the example systems can each be changed, adapted, revised, and/or customized to meet the needs and/or preferences of the patient and/or surgeon. Advantageously, using the apparatus, systems, and/or methods of the present disclosure the surgeon may have a preoperative plan that identifies which specific bone screw (length, width, diameter, thread, pitch, etc.) to use for the fasteners.	399	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	While specific embodiments and applications of the present disclosure have been illustrated and described, it is to be understood that the scope of this disclosure is not limited to the precise configuration and components disclosed herein. Various modifications, changes, and variations which will be apparent to those skilled in the art may be made in the arrangement, operation, and details of the methods and systems of the present disclosure set forth herein without departing from it spirit and scope.	406	Added by DJM Jan 2024	1/6/24, 9:56 PM

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