Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	TMC-PAT-4	In the illustrated embodiment, angle A can be set to enable a rotation (sometimes referred to as a derotation) of the metatarsal in a frontal plane from a deformed position to a corrected position. Advantageously, as with the various other aspects of the resection guide 820c and/or a surgical procedure based on the teachings of the present disclosure, the size of angle A and/or the position of second bone attachment feature 910 can be patient-specific and/or can be determined at least in part based on a model of one or more bones of a patient and/or a model for a resection guide 820c. In certain embodiments, angle A can range from about 2 degrees to about 60 degrees.	403	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The rotational correction of a bone such as a metatarsal is based on an initial position of fasteners deployed in the second bone attachment feature 910 and/or first bone attachment feature 908. In the illustrated embodiment, a first fastener or first pair fasteners of the first bone attachment feature 908 and a second fastener or second pair fasteners are initially deployed such that the fasteners are not aligned with each other along the longitudinal axis 1202 and/or dorsal axis 1206.	404	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Certain embodiments of the present disclosure leverage the position of fasteners (e.g., pins) deployed in the first bone attachment feature 908 and in the second bone attachment feature 910 for multiple purposes. First, the fasteners can be used to indicate for a surgeon the trajectories of osteotomies formed using the proximal resection feature 902 and/or the distal resection feature 904 that are directed along trajectories that are parallel to trajectories that the fasteners are deployed in one or more bones. Second, the fasteners serve to retain the resection guide 820c and keep the resection guide 820c in place while osteotomies are formed. And third, the fasteners are positioned and/or oriented for use to facilitate and aid in reduction of the osteotomies and/or correction of bones as part of the reduction. In the illustrated embodiment, the fasteners in the second bone attachment feature 910 enable rotational correction of the metatarsal as the fasteners of the second bone attachment feature 910 are brought towards and into alignment with the fasteners of the first bone attachment feature 908.	405	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 and distal resection feature 904 may extend through the body 900 from the superior side 914 to the inferior side 916. In one embodiment, the proximal resection feature 902 may guide a cutting tool to form a first osteotomy in one or more bones that extends along a first trajectory 928 (See FIG. 9F, 9G). Similarly, the distal resection feature 904 may guide a cutting tool to form a second osteotomy in one or more bones that extends along a second trajectory 930 (See FIG. 9F, 9G). In one embodiment, the first trajectory may be determined at least partially based on a bone model of a patient’s foot, the bone model defined based on medical imaging of the patient’s foot. Alternatively, or in addition, the second trajectory may be at least partially determined based on the bone model and/or the first trajectory.	286	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The body 900 may include resection features 902, 904 that guide a cutting tool to resect one or more bones, such as a medial cuneiform and/or a first metatarsal in the manner needed to make the desired resection. For example, the resection features 902, 904 may be used to guide a planar cutting blade, an arcuate cutting blade, a drill or mill, a burr, and/or the like. The resection features 902, 904 may guide a reciprocating planar blade, such as that of a surgical bone saw, that forms planar cuts in a first cuneiform and a first metatarsal. Various manual or powered tools may be used to form the cuts. In one embodiment, a sagittal bone saw can be used.	287	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, the proximal resection feature 902 guides a cutting tool to form a first osteotomy in one or more bones of a patient. Similarly, the distal resection feature 904 is used to form a second osteotomy in one or more bones of the patient. Advantageously, the first osteotomy and the second osteotomy can be configured to resect a desired amount, size, and/or shape of bone or bones and/or soft tissue from a midfoot of the patient.	288	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one example, the resection features 902, 904 may take the form of a proximal resection feature 902 and a distal resection feature 904. In one embodiment, the proximal resection feature 902 and the distal resection feature 904 extend from the superior side 914 to the inferior side 916. For example, the proximal resection feature 902 may extend through the body 900 of the resection guide 820b from the superior side 914 to the inferior side 916 along a first trajectory 928. Similarly, the proximal resection feature 902 may extend through the body 900 of the resection guide 820b from the superior side 914 to the inferior side 916 along a second trajectory 930.	289	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The position of the proximal resection feature 902 and/or distal resection feature 904 within the body 900, with relation to each other, the orientation of the proximal resection feature 902 and/or distal resection feature 904 between the proximal side 918 and the distal side 920, and/or the angle of the proximal resection feature 902 and/or distal resection feature 904 through the body 900 may be at least partially determined based on a bone model of a patient’s foot. The bone model may be of one bone or of a plurality of bones. The bone model may be defined based on medical imaging of the patient’s foot. In one embodiment, the first trajectory 928 may be at least partially determined based on the bone model. Similarly, the second trajectory 930 may be at least partially determined based on at least one of the bone model and the first trajectory 928. In this manner, at least in certain embodiments, the number, position, orientation, size, length, angle of incidence to the inferior side 916, and the like are or can be patient-specific. Of course, a surgeon can alter or adjust any of these aspects of the resection guide 820b to enable fabrication of a guide that meets the surgeon’s needs, preferences, and/or the needs of the patient and/or the surgical procedure. In one embodiment, the first trajectory 928 and/or the second trajectory 930 are patient-specific.	290	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In the illustrated embodiment, both the proximal resection feature 902 and the distal resection feature 904 are implemented as slots having two closed ends. Of course, the proximal resection feature 902 and/or distal resection feature 904 can be implemented using a variety of openings, holes, and/or structures. For example, in one embodiment, a proximal resection feature 902 and/or distal resection feature 904 can be implemented as a series of adjacent holes that can be used with a burr cutting tool to form holes in bone for a resection.	291	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 proximal resection feature 902 and/or distal resection feature 904 can have an open end. Alternatively, or in addition, the proximal resection feature 902 and/or distal resection feature 904 can be connected to the body 900 between the ends and both ends can be open ends.	292	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, the proximal resection feature 902 and/or distal resection feature 904 can be defined based on, in connection with, and/or may be defined at least partially based on a bone model 404 of one or more bones of a midfoot of a patient. The bone model 404 provides a detailed and accurate representation of the midfoot bones of the patient. Using the apparatuses, systems, and/or methods of the present disclosure the resection guide 820b and/or its components such as the proximal resection feature 902 and distal resection feature 904 can be configured for a specific patient, for a specific surgical procedure, and/or according to specific user instructions and/or preferences of a user (e.g., surgeon).	293	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, the first trajectory 902 is wholly or at least partially determined based on a bone model 404 of the patient’s foot. In particular, the bone model 404 may be of one or more bones, joints, and/or tissues of a midfoot of the patient. The bone model 404 is defined based on medical imaging of the patient’s foot such that the bone model 404 and surfaces and structures of the bone model 404 are highly accurate representations of the actual midfoot bones of a particular patient. The accuracy of the bone model 404 is such that any protuberance, eminence, bony topography, anatomical features, calcifications, void, divot, concave section, sesamoid, bone spur or other feature on, or extending from, a bone of a patient are represented in the bone model 404 (including on surfaces of model bones of the bone model 404).	294	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Alternatively, or in addition, the second trajectory 904 can be wholly or at least partially determined based on one or both of the bone model 404 and the first trajectory 902. For example, in one embodiment, the bone model 404 is used to determine, at least in part, the second trajectory 904. Alternatively, the second trajectory 904 can be defined to be a certain offset, orientation, and/or angle in relation to the first trajectory 902.	295	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Thus, upon desired positioning of the resection guide 820b for use, the proximal resection feature 902 may be positioned over at least a portion of a bone such as a first medial cuneiform or other midfoot bone while the distal resection feature 904 may be positioned over, for example, a portion of another bone such as a first metatarsal 208. In one embodiment, the proximal resection feature 902 is positioned close to the distal end of a first cuneiform and the distal resection feature 904 is positioned near a proximal end of the first metatarsal. The proximal resection feature 902 and distal resection feature 904 are positioned to guide resection of one or more midfoot bones during a surgical osteotomy for correcting a condition.	296	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In alternative embodiments, a resection feature may be designed to guide a different type of cutter, such as a drill, mill, or side-cutting burr. In such embodiments, the resection feature may not be a slot, but may instead be a translatable or rotatable cutter retainer that guides translation and/or rotation of the cutter relative to the bone. In certain embodiments, two or more resection features may be replaced by a single resection feature sized to permit a surgeon to resect multiple midfoot bones using a resection guide 820b.	297	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, a proximal resection feature 902 is configured to define a first cut surface that can be formed by resecting a first bone. A distal resection feature 904 is configured to define a second cut surface that can be formed by resecting a second bone. In such an embodiment, one or the other or both of the first cut surface and the second cut surface can be oriented according to one or more angles relative to landmarks on the bones or other anatomical structures.	298	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Alternatively, or in addition, in certain embodiments, one or both of, the proximal resection feature 902 and distal resection feature 904 may be positioned on, or in, the body 900 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 902 and distal resection feature 904 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, a position for a proximal resection feature 902, an orientation for a proximal resection feature 902, a position for a distal resection feature 904, an orientation for a distal resection feature 904, as well as other features, aspects, and/or attributes of one or more patient specific instruments that can be used in a procedure.	299	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 9A is a medial-proximal perspective view of one example resection guide 820b. This figure illustrates the proximal side 918, one example of a landmark registration feature 960, and a number of the aspects of the resection guide 820b. In addition, FIG. 9A illustrates one or more markings 970a, 970b or indicators. In the illustrated embodiment, marking 970a is a letter “C” formed by a recessed structure in the shape of the letter “C” and marking 970b is a letter “M” formed by a recessed structure in the shape of the letter “C”. The marking 970a and/or marking 970b can be debossed or embossed. In one embodiment, the one or more markings 970a, 970b or indicators may extend through the resection guide. For example, the one or more markings 970a, 970b or indicators may extend from the superior side 914 to the inferior side 916.	300	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Marking 970a is in the shape of “C” which stands for “Cuneiform” and marking 970b is in the shape of "M” which stands for "Metatarsal”. The marking 970a is positioned towards the proximal end 824 to indicate that this side of the resection guide 820b is to be positioned over the cuneiform of a patient. The marking 970b is positioned towards the distal end 826 to indicate that this side of the resection guide 820b is to be positioned over the metatarsal of a patient. Advantageously, the marking 970a and marking 970b indicate for a surgeon and/or a technician the proper distal to proximal orientation of the resection guide 820b for the surgical procedure. Furthermore, the use of the first character for names of bones derived from Latin and/or the use of markings for letters in a “Latin script” or “Roman script” in which letters and words are written and read from left to right and from top to bottom, enables a user to quickly orient the resection guide 820b such that the medial side 922 is on the medial side of the foot bones and/or a joint (e.g., TMT joint) and the lateral side 924 is on the lateral side of the foot bones and/or the joint. Thus, the marking 970a and marking 970b assist in accurate and correct placement and/or orientation of the resection guide 820b relative to the anatomy of a patient.	301	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, the one or more markings 970a, 970b or indicators may be positioned on one side of the resection guide. (See FIGS. 10A, 10B) In such an embodiment, the one or more markings 970a, 970b or indicators may extend from the superior side 914 to the inferior side 916 which may facilitate identification of a correct and/or desired positioning of the resection guide when viewed with fluoroscopy. In particular, markings 970a, 970b that extend through the material of the resection guide will show up more readily on the scope and can permit visibility to structures underneath the markings 970a, 970b.	302	Added by DJM Jan 2024	1/3/24, 4:24 AM

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