Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	TMC-PAT-4	The superior protrusion 1022 and/or inferior protrusion 1024 guide and/or retain a specific soft tissue in a particular location during use of the resection guide 820c. In the illustrated embodiment, the particular location may be a part of the lateral side 924 between the superior protrusion 1022 and the inferior protrusion 1024. In the illustrated embodiment, the specific tissue may be an Extensor Hallucis Longus (EHL) tendon which typically extends from the extensor hallucis longus muscle towards the big toe, hallux.	363	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, the superior protrusion 1022 may have a planar superior surface and a sloped inferior surface. The planar superior surface may also serve as a handle and/or finger position for a user as a user positions the resection guide 820c during use. The sloped inferior surface can facilitate displacement of the soft tissue towards the lateral side 924 between the superior protrusion 1022 and inferior protrusion 1024. The superior protrusion 1022 may extend two to three times further laterally from the body 900 than the inferior protrusion 1024.	364	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The inferior protrusion 1024 can include a sloped superior surface and a sloped inferior surface. The sloped superior surface can facilitate displacement of the soft tissue towards the lateral side 924 between the superior protrusion 1022 and inferior protrusion 1024. The sloped inferior surface can mitigate damage to other soft tissue while the resection guide 820c is in use.	365	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 10D illustrates that in the example resection guide 820c the second bone attachment feature 910 extends from the superior side 914 to the inferior side 916 at an angle that is not perpendicular to the superior side 914.	366	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 10E is a proximal side view of the resection guide 820c. FIG. 10E illustrates a proximal view of the soft tissue displacement feature 1020. FIG. 10E illustrates that in the example resection guide 820c the first bone attachment feature 908 extends from the superior side 914 to the inferior side 916 at an angle that is perpendicular to the superior side 914. FIG. 10E also illustrates the anchor feature 942. In the illustrated embodiment, the anchor feature 942 is configured to direct a fastener (e.g., K-wire or pin) towards a bone at an angle different from the angle fasteners are deployed using either the first bone attachment feature 908 or the second bone attachment feature 910. In certain embodiments, the anchor feature 942 deploy a fastener at an oblique angle. In the illustrated embodiment, the anchor feature 942 is implemented as a hole configured to receive a fasteners (e.g., K-wire or pin). The anchor feature 942 extends from a surface at or between the superior side 914 and the medial side 922 towards the inferior side 916. Note that in the illustrated embodiment, the anchor feature 942 extends towards the inferior side 916 a relatively short distance (e.g., a few millimeters).	367	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 10E illustrates an embodiment in which the body 900 extends from a medial side M (M Arrow) of a foot bone over a dorsal side D (D Arrow) of the foot bone to a lateral side L (L Arrow) of the foot bone. In this manner, a patient-specific bone engagement feature on an inferior side 916 of the resection guide 820c can contact at least three points on the foot bone. These three contact points can provide a stable and secure placement of the resection guide 820b. In certain embodiments, the patient-specific bone engagement feature (e.g., a bone engagement surface 944) is configured to engage at least a portion of a cuneiform and at least a portion of a metatarsal of a patient when the resection guide 820b is used. The patient-specific bone engagement feature, such as a bone engagement surface 944 and/or a landmark registration feature 1004 (discussed below), can include a contour that is at least partially determined based on a bone model of a patient’s foot. The bone model may be defined based on medical imaging of the patient’s foot.	368	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 10F is a lateral side view of the resection guide 820c. FIG. 10F illustrates the soft tissue displacement feature 1020. In one embodiment, the soft tissue displacement feature 1020 includes a superior protrusion 1022 and an inferior protrusion 1024 as illustrated in FIG. 10F. However, in another embodiment, the soft tissue displacement feature 1020 may not include an inferior protrusion 1024.	369	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In yet another embodiment, the lateral side 924 of the body 900 may be configured to facilitate placement and/or registration of the resection guides 820c to anatomy of the patient. In one example, the lateral side 924 of the body 900 below the superior protrusion 1022 and between the proximal side 918 and the distal side 920 of the lateral side 924 may be divided into two or more planes (e.g., a proximal plane starting from to the proximal side 918 and a distal plane starting from to the distal side 920). In certain embodiments, the lateral side 924 includes a proximal plane that meets a distal plane at a ridge. Advantageously, in certain embodiments, the proximal plane can be oriented to be parallel or substantially parallel to a longitudinal axis of the medial cuneiform 202 when deployed onto a patient and before the surgical procedure is completed. Similarly, the distal plane can be oriented to be parallel or substantially parallel to a longitudinal axis of the first metatarsal 208 when deployed onto a patient and before the surgical procedure is completed. A ridge between the proximal plane and the distal plane may run vertically between the superior protrusion 1022 and the inferior side 916. In this manner, the proximal plane and/or distal plane can be patient-specific. Of course, a surgeon can give instructions regarding an angle for one or more of the proximal plane and/or distal plane. Alternatively, or in addition, the orientation of the proximal plane and/or distal plane can be a standard orientation.	370	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Or the orientation of the proximal plane and/or distal plane can be predefined such that the orientation selected is based on criteria for a certain set of characteristics for a patient (e.g., similar to or the same as patient-matched). Where the orientation of the proximal plane and/or distal plane is set based on a patient-matched embodiment, a plurality of resection guides 820c may be pre-fabricated and the one selected for a particular surgical procedure may be selected based on a set of patient-matched criteria.	371	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 10G is a medial side view of the resection guide 820c. FIG. 10G illustrates the anchor feature 942 and a sloped surface between the medial side 922 and the superior side 914 and a sloped surface between the medial side 922 and the inferior side 916. These sloped surfaces may facilitate deployment of the resection guide 820c and/or may enable deployment with smaller incisions and/or may mitigate damage to surrounding soft tissue during a surgical procedure.	372	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 11 illustrates a medial side view of resection guide 820c according to one embodiment. This figure illustrates trajectories for different aspects of the resection guide 820c. FIG. 11 also illustrates positions and/or angles (e.g., orientation) of one, or both of the resection features (e.g., proximal resection feature 902 and/or distal resection feature 904) and first bone attachment feature 908 and second bone attachment feature 910 relative to each other based on patient imaging data. FIG. 11 also illustrates positions and orientations of resection features and/or bone attachment features in relation to a reference axis 1102, (AP (Anterior-Posterior) axis 1102 that is coincident to a longitudinal axis that extends through a cuneiform and metatarsal of a TMT joint when the guide is used).	373	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Those of skill in the art will appreciate that either the proximal resection feature 902 or the distal resection feature 904 or both the proximal resection feature 902 and the distal resection feature 904 may be angled and/or oriented in relation to the AP axis 1102 and/or a ML (Medial-Lateral) axis (not shown, that extends into and out of FIG. 11) and/or a DP (Dorso-Plantar) axis (vertical within FIG. 11). For example, in certain embodiments, the distal resection feature 904 may be oriented such that an osteotomy formed using the distal resection feature 904 is at an angle perpendicular to the AP axis 1102 and the proximal resection feature 902 may be oriented such that an osteotomy formed using the proximal resection feature 902 is at an angle non perpendicular to the AP axis 1102 and determined to provide correction of orientation of the bones fused in the surgical procedure. Similarly, the angles for the proximal resection feature 902 and/or distal resection feature 904 can be defined relative to the ML axis and/or the DP axis. Alternatively, or in addition, both the proximal resection feature 902 and the distal resection feature 904 can be defined to direct formation of an osteotomy that extends along a trajectory that is angled relative to the AP axis 1102, ML axis, and/or DP axis in order to provide a deformity correction.	374	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In the illustrated embodiment, the proximal resection feature 902 is positioned between the proximal side 918 and the window 906. As explained, the proximal resection feature 902 extends through the body 900 from the superior side 914 to the inferior side 916 along a first trajectory 1104 in a plantar direction at an angle A in relation to AP axis 1102. This orientation of the proximal resection feature 902 enables a cutting tool forming a first osteotomy into a bone to form a cut surface that is also at angle A relative to AP axis 1102. In certain embodiments, angle A can range between about 0 degrees to about 170 degrees. In certain embodiments, angle A may start at 0 degrees and then increase to a positive number of degrees as illustrated or decrease to a negative number of degrees depending on how a surgeon may prescribe adjustments for a correction.	375	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Similarly, the distal resection feature 904 is angled relative to the AP axis 1102. In the illustrated embodiment, the distal resection feature 904 extends through the body 900 from the superior side 914 to the inferior side 916 along a second trajectory 1106 in a plantar direction at an angle B in relation to AP axis 1102. This orientation of the distal resection feature 904 enables a cutting tool forming a second osteotomy into a bone to form a cut surface that is also at angle B relative to AP axis 1102. In certain embodiments, angle B can range between about 0 degrees to about 170 degrees. In certain embodiments, angle B may start at 0 degrees and then increase to a positive number of degrees as illustrated or decrease to a negative number of degrees depending on how a surgeon may prescribe adjustments for a correction. In the illustrated embodiment, the angle B is a 90-degree angle. Making one of the angles A or B for the first trajectory 1104 or second trajectory 1106 perpendicular to the AP axis 1102 can be desirable since a perpendicular cut or resection may be easier to complete, and in particular may be easier to complete on certain bones.	376	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The proximal resection feature 902 and the distal resection feature 904 can be oriented relative to the AP axis 1102, ML axis, and/or DP axis and/or relative to each other. Thus, the proximal resection feature 902 and/or distal resection feature 904 can be angled in one or more planes to provide a biplanar or multiplanar correction.	377	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Similarly, those of skill in the art will appreciate that just as the angle of orientation for the resection features 902, 904 can be predefined and determined, the orientation of one or more holes 940 of one or more bone attachment features 908, 910 can be predefined and determined. Thus, a first bone attachment feature 908 and/or second bone attachment feature 910 can direct a fastener into a bone along a predetermined trajectory.	378	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, the first bone attachment feature 908 (e.g., holes 940 of the first bone attachment feature 908) may direct a first fastener, or set of fasteners, into a bone at an angle C relative to the AP axis 1102. The angle C may be the same, or a similar, to angle A. Accordingly, the first bone attachment feature 908 directs the first fastener, or set of fasteners, into the bone along a third trajectory 1108 that is parallel or substantially parallel to the first trajectory 1104.	379	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In addition, the second bone attachment feature 910 (e.g., holes 940 of the second bone attachment feature 910) may direct a second fastener, or set of fasteners, into a bone at an angle D relative to the AP axis 1102. The angle D may be the same, or a similar, to angle B. Accordingly, the second bone attachment feature 910 directs the second fastener, or set of fasteners, into the bone along a fourth trajectory 1110 that is parallel or substantially parallel to the second trajectory 1106. In certain embodiments, where angle B is a 90-degree angle, angle D may also be a 90-degree angle.	380	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, the first bone attachment feature 908 can direct the fasteners by way of holes 940 that extend into the body 900 at an angle C that provides the third trajectory 1108. The second bone attachment feature 910 can direct the fasteners by way of holes 940 that extend into the body 900 at an angle D that provides the fourth trajectory 1110. The angled holes 764 cause the fasteners to enter the bone at substantially the same angle as the hole extends into the body 900.	381	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, fasteners deployed in holes 940 of the first bone attachment feature 908 and/or second bone attachment feature 910 can serve more than one purpose. First, the fasteners may retain the resection guide 820c in place during formation of the osteotomies. Second, the fasteners may guide a surgeon regarding the planned trajectories for an osteotomy through the proximal resection feature 902 and/or distal resection feature 904. The surgeon can use the deployed fasteners as a proxy for where the osteotomies in the resection features will be.	382	Added by DJM Jan 2024	1/3/24, 4:24 AM

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