Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-23	In the illustrated embodiment, the resection guide 720a is configured with bone attachment features 724 specifically configured to direct fasteners 710 deployed in openings of the bone attachment features 724. A first bone attachment feature 724a is configured to direct a first fastener 710 (not shown in FIG. 10A) along a third trajectory 1014. In the illustrated embodiment, the third trajectory 1014 is parallel to the first trajectory 1010. A second bone attachment feature 724b is configured to direct a second fastener 710 (not shown in FIG. 10A) along a fourth trajectory 1016. In the illustrated embodiment, the fourth trajectory 1016 is parallel to the second trajectory 1012.	321	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In certain embodiments, when a surgeon uses the resection guide 720a, the surgeon may deploy a first fastener 710 in an opening of bone attachment feature 724a and a second fastener 710 in an opening of bone attachment feature 724b into one or more bones of a patient’s midfoot. In one embodiment, the fasteners 710 are made from a radiopaque material such as metal. Next, a surgeon may use an X-ray or fluoroscopy to see where the first fastener 710 and/or second fastener 710 extend into one or more bones of the midfoot of the patient. Advantageously, the surgeon knows that the trajectories (e.g., third trajectory 1014 and fourth trajectory 1016) of the first fastener 710 and second fastener 710 are parallel to the first trajectory 1010 and/or second trajectory 1012. Thus, the surgeon can visualize where the first trajectory 1010 and second trajectory 1012 will extend into the one or more bones. In this example, the third trajectory 1014 indicates the first trajectory 1010 and the fourth trajectory 1016 indicates the second trajectory 1012.	322	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Referring now to FIG. 10A, in the illustrated embodiment, the proximal resection feature 758 comprises an opening that starts on the medial side 744 and extends to the lateral side 746. The opening of the proximal resection feature 758 extends through the body 732 along a first trajectory 1010. In the illustrated embodiment, the distal resection feature 762 comprises an opening that starts on the medial side 744 and extends to the lateral side 746. The opening of the distal resection feature 762 extends through the body 732 along a second trajectory 1012.	323	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	The opening of the proximal resection feature 758 and/or the opening of the distal resection feature 762 has a width and/or length large enough to accommodate, or accept, a cutting element of a cutting tool. In one embodiment, the opening of the proximal resection feature 758 is configured to guide and/or enable a cutting tool to form a first osteotomy into, and/or through, the bone. Advantageously, the first osteotomy tracks, follows, and/or is aligned with the first trajectory 1010. In one embodiment, the opening of the distal resection feature 762 is configured to guide and/or enable a cutting tool to form a second osteotomy into, and/or through, the bone. Advantageously, the second osteotomy tracks, follows, and/or is aligned with the second trajectory 1012. Thus, a surgeon operating the cutting tool within the opening of the proximal resection feature 758 and the distal resection feature 762 can readily form a first osteotomy and a second osteotomy that matches a design that may have been set out in a model of the resection guide 720a and/or a model of the patient’s bone(s).	324	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In one embodiment, the first trajectory 1010 may be determined and/or defined to be a patient-specific feature. Similarly, the second trajectory 1012 may be determined and/or defined to be a patient-specific feature. Advantageously, using the apparatus, methods, and/or systems of the present disclosure a user may determine and/or at least partially determine the first trajectory 1010 and/or the second trajectory 1012 based on a bone model of at least a portion a bone of the patient that is to receive one or more osteotomies. The bone model of at least a portion of the bone can be derived from, and/or based on, medical imaging of a patient’s foot. In certain embodiments, the bone model used to determine, or at least partially determine, the first trajectory 1010 and/or the second trajectory 1012 is configured to resemble, substantially resemble, or match the anatomy of the patient’s foot.	325	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	As used herein, in certain embodiments, partial determination of the first trajectory 1010 and/or the second trajectory 1012 based on a bone model may mean that the bone model for the a bone of a patient that will receive the osteotomies is used together with other imaging data, anatomic data, patient imaging data, patient data, information from a prescription from a doctor, information about surgeon preferences, measurement data taken from the bone model or medical imaging, or the like may also be used to determine the first trajectory 1010 and/or the second trajectory 1012.	326	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	The first trajectory 1010 is at least partially determined based on a bone model of at least a portion of a bone of a patient’s foot. The bone model is based on medical imaging of the patient’s foot and is configured to resemble, significantly resemble, and/or match the anatomy of the patient’s foot. The second trajectory 1012 is at least partially determined based on a bone model of at least a portion of a bone of a patient’s foot. The bone model is based on medical imaging of the patient’s foot and is configured to resemble, significantly resemble, and/or match the anatomy of the patient’s foot.	327	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 first trajectory 1010 and the second trajectory 1012 can define a path for the osteotomies formed using the proximal resection feature 758 and/or distal resection feature 762. Alternatively, or in addition, where a surgical procedure plans to perform a wedge osteotomy, the first trajectory 1010 and the second trajectory 1012 can predefine the size, shape, and configuration of a wedge fragment, or set of bone fragments, formed by the osteotomy.	328	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In one embodiment, a surgeon may desire to perform a wedge osteotomy. In this embodiment, the resection guide 720a is designed such that the first trajectory 1010 converges with the second trajectory 1012 at a vertex 1018 having a wedge angle 1020, such that proximal resection feature 758 and the distal resection feature 762 form a wedge osteotomy comprising a wedge bone fragment (or set of bone fragments in the shape of a wedge) after formation of the first osteotomy and the second osteotomy, the wedge angle 1020 determined based, at least in part, on the bone model 404.	329	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Advantageously, the various aspects of the design of the resection guide 720a and/or an accompanying surgical technique and/or complementary components 730 can be done prior to fabrication of one or more components of the osteotomy system. Thus, a surgeon can define or adjust the position of the vertex 1018, the number of degrees for the wedge angle 1020, a height of the body 730, and the like. Of course, certain of these aspects may be predefined for a surgeon and/or recommendations made to a surgeon. Alternatively, or in addition, certain of these aspects may be patient-specific while others may be standard based on experience and/or established practice for a particular procedure.	330	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In certain embodiments, a surgeon and/or a technician, working with the surgeon, may determine the size, shape, and/or configuration of a wedge bone fragment, or set of bone fragments, to be removed from the bone. Furthermore, a surgeon and/or a technician can determine whether to perform an osteotomy that forms a wedge osteotomy that includes a set of bone fragments after formation of a first osteotomy and a second osteotomy, or an osteotomy that enables an opening wedge osteotomy or an osteotomy that does not include a wedge (closing or opening). The type of osteotomy to be performed can determine whether or not the first trajectory 1010 and/or second trajectory 1012 converge and/or the first trajectory 1010 and/or second trajectory 1012.	331	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In one embodiment, a surgeon can also determine, preoperatively, whether the vertex 1018 will be inside a bone or outside a bone. For example, the surgeon may decide to have the vertex 1018 outside a bone a defined distance away from a later surface (for a medial resection guide, medial surface for a lateral resection guide) of the bone or bones (e.g., medial cuneiform 202). The position of the vertex 1018 may depend on the surgical procedure, surgeon preference, a surgeon’s planned correction, or the like. In such an embodiment, the first trajectory 1010 may converge with the second trajectory 1012 at a vertex 1018 outside the bone and spaced a distance from the later surface (for a medial resection guide, medial surface for a lateral resection guide) of the bone.	332	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIG. 10A illustrates a line to indicate a lateral cortex 1022 of a bone of the midfoot of the patient. In one instance, a surgeon may determine to have the vertex 1018 between the lateral cortex 1022 of the bone and the resection guide 720a when the resection guide 720a is in use for a surgical procedure. In certain osteotomies, a surgeon may desire that the vertex 1018 is positioned within the bone and offset from the lateral cortex 1022 by a predetermined offset 1024. Advantageously, using embodiments of the present disclosure a surgeon can determine and/or adjust the size of the predetermined offset 1024.	333	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	A surgeon may desire to position the vertex 1018 between the lateral cortex 1022 of the bone and the resection guide 720a when the resection guide 720a is in use for a surgical procedure such that the first osteotomy and the second osteotomy leave bone between the vertex 1018 and the lateral cortex 1022 intact. This intact bone may serve to keep two bone fragments connected. Depending on the surgical procedure planned, a surgeon may desire to keep this bone intact to serve as a “living hinge” which can be used to facilitate closing the wedge osteotomy. Of course, different surgeons may have different sizes they want for predetermined offset 1024. Alternatively, or in addition, the size of the predetermined offset 1024 may be based at least in part on how the patient presents for the procedure or preparation and planning for the procedure.	334	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Advantageously, the present disclosure enables the thickness/size of the predetermined offset 1024 to be predetermined, to be patient-specific, as well as the determination of whether or not to have a predetermined offset 1024. As described, a surgeon may preposition the vertex 1018 to be within a bone or outside a bone. In one embodiment, the vertex 1018 is prepositioned to be between a cortex (e.g., lateral cortex 1022) of a bone and the resection guide 720a when the resection guide 720a is used on a patient’s foot. In certain embodiments, the position of the vertex 1018 may be customized to a particular patient. The vertex 1018 position may be patient-specific. Alternatively, or in addition, the position of the vertex 1018 may be set at a default predetermined offset 1024, such as one millimeter. In another embodiment, the position of the vertex 1018 may be predetermined, for example due to the type of osteotomy being performed.	335	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In one embodiment, the position of the vertex 1018 may be fixed due to the type of osteotomy to be performed. Those of skill in the art will appreciate that with a fixed position of the vertex 1018 and based on a thickness of the bone at the location for the osteotomy, the size of the wedge angle 1020 can directly impact the width of the body 730. Those of skill in the art will appreciate that the size of the wedge angle 1020 can vary depending on the needs of the patient, surgeon preferences, anatomical data, or the like. In one embodiment, the wedge angle 1020 may range from between about 5.0 degrees to about 45.0 degrees. In one embodiment, the wedge angle 1020 is about 13.4 degrees. In another embodiment, the wedge angle 1020 is about 18.3 degrees. Advantageously, a user or surgeon can define and/or adjust the wedge angle 1020 in a tool that views and/or edits parameters for the bone model and/or for a model of the resection guide 2020. In one embodiment, the wedge angle 1020 is determined at least on part based on the bone model 404.	336	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIG. 10B illustrates a medial side view of patient-specific guide according to one embodiment. FIG. 10B also illustrates the three-dimensional axis 1000, oriented based on how a medial patient-specific guide is oriented during use. The three-dimensional axis 1000 includes a medial-lateral axis 1002, a dorsal-plantar axis 1004, and an anterior-posterior axis 1006. FIGs 10A and 10B illustrate that the resection features 722 can be positioned and oriented in any angle in relation to two or more planes of the patient’s anatomy.	337	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIG. 10B illustrates that the proximal resection feature 758 may extend through the body 732 parallel to the medial-lateral axis 1002. In certain embodiments, a surgeon may desire one cut surface of the surgical procedure to be parallel with the medial-lateral axis 1002 such that the perpendicular cut surface can serve as a known reference plane for an arthrodesis procedure. FIG. 10B also illustrates that the distal resection feature 762 may be oriented at an angle C measured from the dorsal-plantar axis 1004 that includes the proximal resection feature 758. Angle C can range between about 5 degrees and about 50 degrees.	338	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In the illustrated embodiment, the distal resection feature 762 extends posteriorly from the dorsal-plantar axis 1004 at an angle D. Angle D can range between about 5 degrees and about 50 degrees. Advantageously, a surgeon can determine what values are desired for angles A, B, C, and D. In this manner, a surgeon can customize the surgical procedure for a particular patient.	339	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 position and orientation of the proximal resection feature 758 and distal resection feature 762 and the corresponding cut surfaces a surgeon can form using these resection features can vary depending on the anatomical structures of the patient, the osteotomy procedure being performed, preferences of the surgeon, the nature of the condition, and the like. For example, in the illustrated embodiment, angle D may be greater than about 25 degrees. In another embodiment, angle D may be smaller and angle C may be greater. Of course, in another embodiment, the proximal resection feature 758 and distal resection feature 762 may be parallel (0 degrees for angle D and 90 degrees for angle C).	340	Added by DJM Jan 2024	1/6/24, 9:56 PM

Page 6 of 21, showing 20 record(s) out of 407 total