Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	TMC-PAT-4	In certain embodiments, a surgeon may use medical imaging to confirm that the trajectories of deployed fasteners into the bone(s) using the holes 940 are where the surgeon had planned them and/or wants them, and that the surgeon still wants to proceed with the resections. If the surgeon is not comfortable proceeding with the procedure with the given resection guide 820c after reviewing the trajectories indicated by the fasteners under fluoroscopy, in certain embodiments, the surgeon may deploy an alternative resection guide 820c that is configured to provide a different trajectory for one or more resection cuts into one or more bones. Alternatively, the surgeon may make a different change to the surgical plan to accommodate the needs of the patient and/or preferences of the surgeon.	383	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one example, when a surgeon uses the resection guide 820c, the surgeon may deploy a first fastener in an opening of first bone attachment feature 908 and a second fastener in an opening of second bone attachment feature 910 into one or more bones of a patient’s midfoot. In one embodiment, the fasteners 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 and/or second fastener extend into one or more bones of the midfoot of the patient. Advantageously, the surgeon knows that the trajectories (e.g., third trajectory 1108 and fourth trajectory 1110) of the first fastener and second fastener are parallel to the first trajectory 1104 and/or second trajectory 1106. Thus, the surgeon can visualize where the first trajectory 1104 and second trajectory 1106 will extend into the one or more bones. In this example, the third trajectory 1108 indicates the first trajectory 1104 and the fourth trajectory 1110 indicates the second trajectory 1106.	384	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, each bone attachment feature may include one or more holes 940. More than one or two holes 940 for each bone attachment feature can be advantageous because additional holes 940 can provide a more stable placement of the resection guide 820c. For example, a fastener in a second or third hole can help keep the resection guide 820c from pivoting or rotating about a single fastener in a single hole.	385	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Referring now to FIG. 11, in the illustrated embodiment, the proximal resection feature 902 comprises an opening that starts on the superior side 914 and extends to the inferior side 916. The opening of the proximal resection feature 902 extends through the body 900 along a first trajectory 1104. In the illustrated embodiment, the distal resection feature 904 comprises an opening that starts on the superior side 914 and extends to the inferior side 916. The opening of the distal resection feature 904 extends through the body 900 along a second trajectory 1106.	386	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The opening of the proximal resection feature 902 and/or the opening of the distal resection feature 904 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 902 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 1104. In one embodiment, the opening of the distal resection feature 904 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 1106. Thus, a surgeon operating the cutting tool within the opening of the proximal resection feature 902 and the distal resection feature 904 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 820c and/or a model of the patient’s bone(s).	387	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, the first trajectory 1104 may be determined and/or defined to be a patient-specific feature. Similarly, the second trajectory 1106 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 1104 and/or the second trajectory 1106 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 1104 and/or the second trajectory 1106 is configured to resemble, substantially resemble, or match the anatomy of the patient’s foot.	388	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	As used herein, in certain embodiments, partial determination of the first trajectory 1104 and/or the second trajectory 1106 based on a bone model may mean that the bone model for 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 to determine the first trajectory 1104 and/or the second trajectory 1106.	389	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The first trajectory 1104 may be 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 may be 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 1106 may be 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 may be 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.	390	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 11 illustrates one example of an anchor feature 942. The anchor feature 942 may include an anchor and in one embodiment, the anchor may be implemented by way of a hole or opening in a structure configured to guide a fastener into a bone at a predetermined angle in one or more of a dorsal plane, a frontal plane, and a transverse plane.	391	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In the illustrated embodiment, the anchor feature 942 includes an anchor that is positioned near the medial side 922 and extends towards the proximal end 824. The anchor includes a hole sized to receive a fastener such as a K-wire or pin that can be deployed into a bone after passing through the hole. The anchor is configured to guide the fastener along a fifth trajectory 1112. In certain embodiments, the fifth trajectory 1112 is different from one or the other, or both, of the first trajectory 1104 and the second trajectory 1106. Of course, the fifth trajectory 1112 can be the same or substantially the same as the first trajectory 1104 or the second trajectory 1106.	392	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In the illustrated embodiment, the anchor feature 942, such as an anchor may extend from the superior side 914 mediolaterally towards the inferior side 916 for a distance sufficient to guide a fastener in a hole of the anchor feature 942 along a particular trajectory. Those of skill in the art will appreciate that this means that the length of a body of the anchor defining the hole can be minimized to reduce the size, weight and use of material of a resection guide 820c. Alternatively, or in addition, body of the anchor defining the hole to a variety of lengths between the superior side 914 and the inferior side 916.	393	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, a surgeon can determine what values are desired for angles A, B, C, D, and E. In this manner, a surgeon can customize the surgical procedure for a particular patient. Advantageously, the various aspects of the design of the resection guide 820 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 resection features, the position and/or orientation of the bone attachment features, a height of the body 900 (measured between the superior side 914 and the inferior side 916), 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.	394	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 the position and orientation of the proximal resection feature 902 and distal resection feature 904 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.	395	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 12 illustrates a lateral perspective view of a resection guide 820c according to one embodiment. FIG. 12 illustrates a longitudinal axis 1202 that runs in an AP direction. In certain embodiments, the longitudinal axis 1202 may be coincident with the AP axis 1102. In the illustrated embodiment, the longitudinal axis 1202 is coincident with a longitudinal axis of a cuneiform when the resection guide 820c is positioned for use. Alternatively, or in addition, the longitudinal axis 1202 may be coincident with a longitudinal axis of a metatarsal when the resection guide 820c is positioned for use. In contrast, to the illustration in FIG. 12, where the metatarsal is in a deformed position, the longitudinal axis 1202 may extend in a mediolateral direction.	396	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Whether the longitudinal axis 1202 is coincident with a longitudinal axis of cuneiform or a metatarsal of a TMT, one goal of a surgical procedure to correct a deformity of the metatarsal may include translating the metatarsal in the transverse plane such that a longitudinal axis of the metatarsal is coincident with, or parallel to, the longitudinal axis of the cuneiform as a result of the surgical procedure.	397	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 12 also illustrates a dorsal-plantar (DP) axis 1204 that is perpendicular to the longitudinal axis 1202. FIG. 12 illustrates that the first bone attachment feature 908 is configured to align longitudinally with a dorsal axis 1206 that runs parallel to the longitudinal axis 1202. In the illustrated embodiment, the holes 940 of the first bone attachment feature 908 are configured such that fasteners in the holes are parallel to each other and the pair of fasteners are aligned with the dorsal axis 1206. As described above, a first pair of fasteners deployed in the holes 940 of the first bone attachment feature 908 are directed by the holes 940 along a third trajectory 1108 (See FIG. 11) that is parallel to the first trajectory 1104. In certain embodiments, the position of the first bone attachment feature 908 can be configured to be patient-specific and can be configured to direct the fasteners into approximately a center of the dorsal cortex of a bone such as a cuneiform.	398	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, one or more of the bone attachment features may be positioned along a side of the resection guide in order to aid a surgeon in accurate positioning of the resection guide for the surgical procedure. In one example, the first bone attachment feature 908 may be specifically positioned along the proximal side 918 so that an arm that connects the first bone attachment feature 908 to the body is aligned with the dorsal axis 1206 that runs parallel to the longitudinal axis 1202. In one embodiment, the longitudinal axis 1202 may be coaxial with a long axis of a cuneiform involved in the surgical procedure. In another embodiment, the longitudinal axis 1202 may be coaxial with a long axis of a metatarsal involved in the surgical procedure in a deformed condition (preoperatively). In yet another embodiment, the longitudinal axis 1202 may be coaxial with a long axis of a metatarsal involved in the surgical procedure in a corrected condition (postoperatively).	399	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, the surgeon can use the arm that connects the first bone attachment feature 908 to the body as a guide using fluoroscopy to gauge where the parallel long axis 1202 runs and thereby determine and/or confirm whether the resection guide is in a desired position relative to bone(s) of the patient. Furthermore, this can be done before forming any osteotomies, this can help assure the surgeon that the surgical procedure is proceeding as planned.	400	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 12 also illustrates that the second bone attachment feature 910 is not aligned longitudinally with the first bone attachment feature 908. Instead, the second bone attachment feature 910 is positioned towards the medial side 922 of the resection guide 820c. In the illustrated embodiment, the second bone attachment feature 910 is configured to direct a second pair of fasteners along a fourth trajectory 1110 (See FIG. 11) that is parallel to the second trajectory 1106. FIG. 12 illustrates that the fourth trajectory 1110 is offset from the DP axis 1204 by an angle A. The angle A can be configured to position and direct the pair of fasteners deployed in the second bone attachment feature 910 into approximately a center of a surface of a bone such as a metatarsal that faces the second bone attachment feature 910.	401	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, such as the illustrated embodiment, the position of the second bone attachment feature 910 along the distal side 920 and/or size of the angle A are determined to enable an additional correction to a deformity of anatomy of a patient. Often, when a patient has a deformity that calls for a Lapidus surgical procedure to correct the deformity, the patient also has a condition in which the metatarsal has rotated medially about the longitudinal axis 1202 (e.g., AP axis) such that sesamoids near the distal end of the metatarsal extend laterally rather than plantarly. Advantageously, embodiments of the present disclosure enable correction of both the orientation of the metatarsal as well as rotation of the metatarsal within the frontal plane to correct the position of the sesamoids.	402	Added by DJM Jan 2024	1/3/24, 4:24 AM

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