Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-23	Alternatively, or in addition, in certain embodiments, one or both of, the proximal resection feature 758 and distal resection feature 762 may be positioned on, or in, the body 732 and/or have an orientation based on patient imaging data. The patient imaging data can be used to position and orient one, or both, of the proximal resection feature 758 and distal resection feature 762 such that formation of one, or both, of the first cut surface and the second cut surface and fixation of the two cut surfaces against each other mitigates a condition of the patient. For example, as described in the present disclosure, patient imaging data can be used to generate bone models of bones of the patient. The bone models can be used to determine and/or define contours for a bone engagement surface 726, a position for a proximal resection feature 758, an orientation for a proximal resection feature 758, a position for a distal resection feature 762, an orientation for a distal resection feature 762, as well as other features and attributes of one or more patient specific instruments that can be used in a procedure.	270	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	The resection guide 720 includes one or more bone attachment features 724. The bone attachment features 724 are configured to engage one or more bones of the patient to couple the body 732 to one or more bones of the patient. As embodied in FIGs. 9A through 9G, the bone attachment features 724 may take the form of one or more holes 764 that extend from the medial side 744 to the lateral side 746 and/or one or more fixation devices (e.g., fasteners 710). The holes 764 may be shaped to accommodate pins, K-wires, and/or other elongated bone fixation elements that can be anchored in a first cuneiform and/or a first metatarsal to keep the resection guide 720 in place.	271	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In the illustrated embodiment, the posterior side 736 includes a first bone attachment feature 766 and the anterior side 734 includes a second bone attachment feature 768. In one embodiment, the holes 764 of the first bone attachment feature 766 are aligned with the second bone attachment feature 768. Alternatively, or in addition, the first bone attachment feature 766 and second bone attachment feature 768 are not aligned with each other.	272	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	When a surgeon prepares to do an osteotomy, they take care to prepare for the surgical procedure by gathering as much information as possible about the patient’s anatomy, the surgical procedure, the instrumentation that will be used, and any implants to be used such that the goals of the surgical procedure can be realized. This preparation helps because once an osteotomy is performed changing or remediating the impact of the osteotomy can be challenging and can take time for bones to heal and recover. Thus, a surgeon seeks to perform osteotomies that are only in the desired locations, with the desired trajectories, and to a desired depth. The goal of the osteotomies is to provide a correction and/or relief for a patient.	273	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	To facilitate a successful surgical procedure, surgeons appreciate any guidance and advanced indications of signs as to where an osteotomy will be made and/or how the osteotomy will extend into the tissue of the patient and how a reduction after the osteotomy will do in providing for the desired outcome. One sign or indicator that surgeons appreciate is a trajectory marker that is in one or more bones of the patient and indicates the trajectory the osteotomy will take. Advantageously, the present disclosure can provide such indicators by way of the bone attachment features 724.	274	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In one embodiment, the bone attachment features 724 are configured to enable fasteners 710 used with the bone attachment features 724 to extend into one or more bones of the patient. Specifically, the fasteners 710 can be deployed into the bone attachment features 724 and will thereby show a surgeon what the trajectory will be for an osteotomy formed using the resection features 722. In certain embodiments, this can be accomplished because a hole 764 for a bone attachment feature 724 may extend through the body 732 to guide the fasteners 710 along a trajectory that is parallel to the trajectory of the resection feature 722 (e.g., first trajectory 902 and/or second trajectory 904) for the osteotomy that the cutting tool will cut. Of course, this parallel relationship can be implemented in one or more of the bone attachment features 724 of the resection guide 720a.	275	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Advantageously, a surgeon can leverage this feature prior to making any cuts, forming any osteotomies. For example, a surgeon can secure the resection guide 720a to one or more bones of the patient on a medial side of the midfoot. The fasteners 710 cooperating with the bone attachment features 724 can extend into the middle, and/or through to the lateral side of the midfoot. Since the fasteners 710 are often made of metal, the surgeon can then use fluoroscopy to visually see and/or check the trajectory for each fastener 710 into the midfoot. The surgeon knows that an adjacent and parallel osteotomy formed using the resection features 722 will track with the trajectories of the fasteners 710 in the bone attachment features 724. In this manner, a surgeon can confirm trajectories for the planned osteotomies before the actually making the osteotomies. If the surgeon is not satisfied with the trajectories indicated by the bone attachment features 724 by way of the deployed fasteners 710 a surgeon can make an adjustment and removing the fasteners 710 has minimal impact on the patient and/or the success of the procedure.	276	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	The body 732 connects the proximal resection feature 758 to the distal resection feature 762. Alternatively, or in addition, the body 732 connects to the bone attachment features 724. In one embodiment, the resection guide 720 may include a connector 733 or coupler 733. The connector 733 may be a part of the body 732 or a separate component. The connector 733 is between the proximal resection feature 758 to the distal resection feature 762.	277	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In certain embodiments, a user may provide user instructions regarding the size and/or configuration of the body 732 and/or the connector 733. For example, the user may wish to make the body 732 as small and narrow as possible. A larger resection guide 720 may require larger incisions which could lead to longer recovery times for a patient. However, the smaller the body 732, the less surface area of a patient-specific bone engagement feature, such as a bone engagement surface on a bone facing side of the resection guide 720. The smaller patient-specific bone engagement feature may make positioning the resection guide 720 in a predetermined position more challenging. Thus, the user (e.g., surgeon) may weigh the benefits and challenges in the trade-off between the size of the body 732 and/or connector 733 and corresponding size of a patient-specific bone engagement feature versus the ease of positioning the resection guide 720 during the surgical procedure.	278	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	As described in the present disclosure, a resection guide 720a can be specifically designed for a particular patient. The resection guide 720 is patient-specific. The resection guide 720 facilitates making one or more osteotomies through one or more bones of a midfoot of a patient. In addition, the resection guide 720 assists a surgeon in knowing that a position of a resection guide 720 during surgery is the same or substantially the same as a predetermined position defined earlier. In one embodiment, the predetermined position is a position that has been defined and/or confirmed and/or agreed to by the surgeon using the bone model 404 and/or a model of the resection guide 720. In the system 400, for example, a surgeon can use a registration module 440 to register a preliminary model of the resection guide 720 to one or more bones of the bone model 404. Using the apparatus 402, a surgeon can leverage a patient-specific model of one or more bones of a patient and a model of the resection guide 720 to define one or more patient-specific bone engagement features for the resection guide 720. In this manner, the predetermined position includes a position on one or more bones of a patient. The predetermined position may be defined preoperatively using a model of a resection guide and a bone model.	279	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In one embodiment, the resection guide 720 (e.g., resection guide 720a) includes at least one patient-specific bone engagement feature. A patient-specific bone engagement feature serves to engage with one or more bones and/or other tissue of a patient to position or identify a position of the resection guide 720 relative to the one or more bones that satisfies and/or matches a predetermined position defined using the models (e.g., bone model 404 and/or preliminary model of the resection guide 720). In certain embodiments, a patient-specific bone engagement feature is one example of a reference feature that can assist a user (e.g., surgeon).	280	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIG. 9C illustrates one example of a patient-specific bone engagement feature 906. The patient-specific bone engagement feature 906 is configured to engage at least a portion of one or more bones of a patient during a surgical procedure. The patient-specific bone engagement feature 906 engages the one or more bones and/or joints in a manner that positions the resection guide 720 in a predetermined position. Advantageously, the patient-specific bone engagement feature 906 includes features, structures, and/or aspects that provide feedback to a user moving the resection guide 720 in relation to surfaces of one or more bones of the patient. These features, structures, and/or aspects of the patient-specific bone engagement feature 906 cause the resection guide 720 to shift and tilt as a user moves the resection guide 720 to an approximate position on the bones. However, since the features, structures, and/or aspects are mirror images of the recesses, bumps, projections, and/or surface features of the one or more bones, the resection guide 720 will lock into place once the resection guide 720 is moved to the same (or substantially the same) position on or relative to the one or more bones as the predetermined position. The patient-specific bone engagement feature 906 causes the resection guide 720 to lock and/or snap into place once the correct position that matches the predetermined position is located.	281	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 a patient-specific bone engagement feature 906 can take a variety of forms and/or configurations and can include a single structure or a plurality of structures that together form the patient-specific bone engagement feature 906. The patient-specific bone engagement feature 906 can be a single surface (e.g., a bone engagement surface) that is contoured, a surface in cooperation with a body structure that accounts for rises or falls in a contour of the one or more bones. Alternatively, or in addition, a patient-specific bone engagement feature 906 can include a struct or arm or other structure that extends from the body 732 and supports a contoured bone engagement surface.	282	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In the example of FIG. 9C, the patient-specific bone engagement feature 906 can take the form of a bone engagement surface 726. The bone engagement surface 726 may include a portion, some, or all of a surface of one side of a resection guide 720. In certain embodiments, a bone engagement surface 726 can include two or more sections. Each section may be a bone engagement surface 726. Alternatively, or in addition, one section may be a bone engagement surface 726 and another section may be planar or at least not contoured to match or mirror a surface of one or more bones and/or other tissue of a patient.	283	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In certain embodiments, the bone engagement surface 726 includes a patient-specific feature that is defined to interface with at least a portion of a surface that includes one or more bones of a patient. The patient-specific feature can be a single feature or a plurality of features. These features may be structures that are configured and sized to fit into and/or engage with corresponding features of a surface. For example, one feature may be a protrusion, projection, extension, or the like sized and shaped to fit within a recess or opening or cavity in a surface of, or between, bones of a patient. Alternatively, a patient-specific feature can be an opening, recess, cavity, detent, or the like sized and shaped to accept a projection, extension or the like from a surface or other structure of, or between bones, of a patient.	284	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIG. 2E is a view of a foot illustrating common planes 260 of reference for a human foot. FIG. 2E illustrates a sagittal plane 262 that divides the foot into a right section and a left section half. The sagittal plane 262 is perpendicular to frontal or coronal plane 264 and the transverse plane 266. In the foot, the frontal plane 264 generally runs vertically through the ankle and the transverse plane 266 generally runs horizontally through the midfoot and toes of the foot.	162	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Every patient and/or condition is different; accordingly, the degree of angular adjustment needed in each direction may be different for every patient. Use of a patient-specific instrument may help the surgeon obtain an optimal realignment, target, or position a bone tunnel, position one or more resections and/or fasteners and the like. Thus, providing patient-specific instruments, jigs, and/or instrumentation may provide unique benefits.	163	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	The present patient-specific instrumentation may be used to correct a wide variety of conditions. Such conditions include, but are not limited to, angular deformities of one bone in either the lower or upper extremities (for example, tibial deformities, calcaneal deformities, femoral deformities, and radial deformities). The present disclosure may also be used to treat an interface between two bones (for example, the ankle joint, metatarsal cuneiform joint, lisfranc's joint, complex Charcot deformity, wrist joint, knee joint, etc.). As one example, an angular deformity or segmental malalignment in the forefoot may be treated, such as is found at the metatarsal cuneiform level, the midfoot level such as the navicular cuneiform junction, hindfoot at the calcaneal cuboid or subtalar joint or at the ankle between the tibia and talar junction. Additionally, patient-specific instruments could be used in the proximal leg between two bone segments or in the upper extremity such as found at the wrist or metacarpal levels.	164	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIG. 3 illustrates a flowchart diagram depicting a method 300 for generating one or more instruments (which may or may not be patient-specific) configured to correct or address a bone or foot condition, according to one embodiment. Prior to steps of the method 300, a bone model (also referred to as CAD model above) is generated. The bone model may be generated using medical imaging of a patient’s foot and may also be referred to as an anatomic model. The medical imaging image(s) may be used by computing devices to generate patient imaging data. The patient imaging data may be used to measure and account for orientation of one or more structures of a patient’s anatomy. In certain embodiments, the patient imaging data may serve, or be a part of, anatomic data for a patient.	165	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In one embodiment, the method 300 begins after a bone model of a patient’s body or body part(s) is generated. In a first step 302, the method 300 may review the bone model and data associated with the bone model to determine anatomic data of a patient’s foot.	166	Added by DJM Jan 2024	1/6/24, 9:56 PM

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