Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Application	Content	Paragraph Number	Notes	Modified
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View Edit Delete	PER-20	As further shown in FIG. 13, method 1300 may include sliding a distal resection guide over the two distal guide pins until the distal resection guide contacts the metatarsal, the distal resection guide having a metatarsal resection feature configure to guide resection of the metatarsal (block 1314). For example, a surgeon may slide a distal resection guide over the two distal guide pins until the distal resection guide contacts the metatarsal, the distal resection guide having a metatarsal resection feature configure to guide resection of the metatarsal, as described above.	303	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	As also shown in FIG. 13, method 1300 may include inserting a cutting tool into the metatarsal resection feature to create an osteotomy of the metatarsal (block 1316). For example, a surgeon may insert a cutting tool into the metatarsal resection feature to create an osteotomy of the metatarsal, as described above.	304	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	As further shown in FIG. 13, method 1300 may include sliding a positioning guide over the two proximal guide pins and the two distal guide pins until the positioning guide contacts the cuneiform and the metatarsal, where the positioning guide causes a cut face of the osteotomy of the cuneiform to contact a cut face of the osteotomy of the metatarsal (block 1318). For example, a surgeon may slide a positioning guide over the two proximal guide pins and the two distal guide pins until the positioning guide contacts the cuneiform and the metatarsal, where the positioning guide causes a cut face of the osteotomy of the cuneiform to contact a cut face of the osteotomy of the metatarsal, as described above.	305	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The resection guide provides an accurate and precise guide for performing one or more osteotomies on a bone of a patient. In particular, the resection guide is specifically designed and engineered for one or more osteotomies at or near an end of a metatarsal bone and/or a cuneiform bone of the patient. Advantageously, the variability and flexibility provided for the design of the resection guide enable an innumerable set of resection guides that can be fabricated.	284	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Similarly, the proximal alignment feature 944 may serve as a second anchor for the positioning guide 880. Before and after an osteotomy of a cuneiform or a metatarsal, the proximal alignment feature 944 and the distal alignment feature 946 may not be aligned with each other along a longitudinal axis of the first metatarsal 208. However, the positioning guide 880 may include distal and proximal holes that engage with the proximal alignment feature 944 and the distal alignment feature 946 such that sliding the positioning guide 880 towards the bones along proximal alignment feature 944 and the distal alignment feature 946 brings the bones and these two features into alignment with each other along the longitudinal axis of the first metatarsal 208.	246	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Referring now to FIGS. 9A, 9B, and 9C, the illustrated embodiment includes two markers 920 that each are implemented using structures that serve multiple purposes. In addition, to identifying a location for reference features that may serve as alignment features, the markers 920 function as bone attachment features and reference features used with the bone attachment features may also serve as resection guide anchors.	247	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In the illustrated embodiment, the navigation guide 900 includes a marker 920 that serves as a set of proximal bone attachment features 950 and a marker 920 that serves as a set of distal bone attachment features 952. The set of proximal bone attachment feature 950 and set of distal bone attachment feature 952 may include holes through the body 906 or guide pins that are deployed using those holes or a combination of both the holes and the guide pins deployed using those holes. The set of proximal bone attachment features 950 and/or set of distal bone attachment features 952 serve to hold the navigation guide 900 securely to the bone(s) as a set of proximal guide pins 928 and/or a set of distal guide pins 930 are deployed. Keeping the navigation guide 900 securely in place ensures that the guide pins are deployed where desired, particularly based on a preoperative plan.	248	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Alternatively, or in addition, the set of proximal bone attachment feature 950 are configured to identify a location for a proximal reference feature (e.g., a set of proximal guide pins 928) and the set of distal bone attachment feature 952 are configured to identify a location for a distal reference feature (e.g., a set of distal guide pins 930). In certain embodiments, the proximal reference feature may be positioned and/or located on a cuneiform of a patient’s foot and the distal reference feature may be positioned and/or located on a metatarsal of a patient's foot. The proximal reference feature may correspond to a proximal model reference (e.g., a set of model guide pins) on a cuneiform model of the cuneiform of the patient. The set of proximal bone attachment feature 950 are configured to receive the set of proximal guide pins 928 that serve as the proximal reference feature. The distal reference feature may correspond to a distal model reference (e.g., a set of model guide pins) on a metatarsal model of the metatarsal of the patient. The set of distal bone attachment feature 952 are configured to receive the set of distal guide pins 930 that serve as the distal reference feature.	249	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	As discussed above, reference features may be used for multiple purposes during a surgical procedure. Using reference features for multiple purposes can be advantageous because the bones of a patient (particularly in a foot or hand) are small and surgical procedures are more successful the fewer number of guide pins are used and the smaller the guide pins are. Using reference features such as guide pins for multiple purposes can reduce the number of guide pins used and/or reduce the number of holes formed in bones of the patient. These advantages can improve patient care and successful outcomes.	250	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In the illustrated embodiment, a proximal/first reference feature (e.g., a set of proximal guide pins 928) and a distal/second reference feature (e.g., a set of distal guide pins 930) can be used as alignment features for a positioning guide and can also serve as anchors for other instruments during a surgical procedure. In the illustrated embodiment, the proximal/first reference feature serves as a proximal alignment feature 944 and as a proximal resection guide anchor 954 and the distal/second reference feature serves as a distal alignment feature 946 and as a distal resection guide anchor 956.	251	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	A guide anchor is an anchor for a resection guide (described herein). The guide anchor serves to hold a resection guide in place during an osteotomy. In one embodiment, a guide anchor is strategically placed guide pins that pass through a resection guide and hold the resection guide securely to a bone of a patient for the osteotomy. A proximal resection guide anchor 954 is a guide anchor that is proximal during a surgical procedure. A distal resection guide anchor 956 is a guide anchor that is distal during a surgical procedure. In certain embodiments, a proximal resection guide anchor 954 may be deployed in a cuneiform and a distal resection guide anchor 956 may be deployed in a metatarsal. Advantageously, because the surgical procedure is preplanned using medical imaging of bones of a patient the same guide pins that serve as a proximal reference feature and those that serve as a distal reference feature can also serve as a proximal resection guide anchor 954 and a proximal alignment feature 944 and as a distal resection guide anchor 956 and a distal alignment feature 946. Those of skill in the art will appreciate that a reference feature can serve as an alignment feature or a resection guide anchor or both depending on the embodiment. Advantageously, the navigation guide 900 may identify where to position the first reference feature and the second reference feature for use for resection or cutting of one or more bones and for alignment and repositioning of bone fragments after the osteotomies.	252	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Referring to FIG. 9C, the navigation guide 900 can include a registration key 938 on the inferior side 918 of the body 906. In the illustrated embodiment, the registration key 938 includes a protrusion that engages an opening between a cuneiform and a metatarsal of a tarsometatarsal (“TM”) joint. FIG. 9C illustrates that the navigation guide 900 can include a bone engagement surface 922 configured to register to an anatomical structure of at least one of the cuneiform, the metatarsal, and the TMT joint, the bone engagement surface 922 is defined based on medical imaging taken of the metatarsal and the cuneiform of the patient’s foot.	253	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	FIGS 9A, 9B, 9C illustrate that the set of proximal holes 924 and set of distal holes 926 are not aligned when measured along a length of the longitudinal axis 940. As discussed, this positioning is intentional because while the holes are not aligned initially, the implementation of the procedure will prepare the bones such that as the procedure completes guide pins deployed in the holes will be aligned with each other along a length of the longitudinal axis 940. Accordingly, the set of proximal holes 924 and/or set of distal holes 926 are not aligned with respect to a longitudinal axis of one of the bones of a patient.	254	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	FIG. 9D illustrates a diagram representative of a cross-sectional view of cuneiform and a first metatarsal from a cuneiform looking towards a distal head of the metatarsal. FIG. 9D further illustrates the offset relationship between the set of proximal holes 924 and the set of distal holes 926. FIG. 9D illustrates an axis 958 that corresponds to a long axis of a long bone such as a metatarsal. The circle 960 represents an approximate perimeter viewed along the axis 958.	255	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	FIGS. 9A-9C illustrate the relationship between the set of proximal holes 924 and the set of distal holes 926. Specifically, the proximal set of holes is spaced from the distal set of holes longitudinally along a long axis of the bone (e.g., metatarsal). FIG. 9D illustrates that the proximal set of holes (e.g., set of proximal holes 924) is offset about the long axis 958 by an angle alpha A from the distal set of holes (e.g., set of distal holes 926). Angle A represents the number of degrees of offset between the set of proximal holes 924 and the set of distal holes 926 measured about circle 960. In certain embodiments, angle A may range between about 3 and about 100 degrees. It should be noted that in certain embodiments, Angle A can also represent a number of degrees between the first position for a metatarsal prior to an osteotomy and the surgical procedure and a second position that the bone will be rotated to about the longitudinal axis 958 to reduce and complete the surgical procedure.	256	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	FIG. 10A illustrates an exploded view of a navigation guide 900 according to one embodiment. In the illustrated embodiment, the navigation guide 900 includes a coupler 942. Those of skill in the art will appreciate that a variety of structures and/or techniques may be used to implement or realize a coupler with the scope of the present disclosure. FIG. 10A illustrates just one example.	257	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In the illustrated embodiment, the coupler 942 includes a bolt 962, a head opening 964 in one of the proximal end 902 and the distal end 904, and a shaft opening 966 in the other one of the proximal end 902 and the distal end 904. In the illustrated embodiment, the head opening 964 is in the proximal end 902 and the shaft opening 966 is in the distal end 904.	258	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The bolt 962 may include a head 968 and a shaft 970. The head 968 may include a drive feature 972. The shaft 970 may include a set of threads 974 on an external surface of the shaft 970.	259	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The head opening 964 is configured to contact and/or accept at least part of a head 968 of the bolt 962. The shaft opening 966 is configured to accept at least part of a shaft 970 of the bolt 962. In one embodiment, the shaft opening 966 includes internal threads 976 configured to engage the set of threads 974 on the external surface of the shaft 970.	260	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In one embodiment, the coupler 942 may be deployed by a fabricator of the coupler 942. Thus, initially the proximal end 902 and the distal end 904 may be joined by the coupler 942 and the navigation guide 900 ready for use by a user or surgeon. Advantageously, the coupler 942 is configured to be operated to separate the proximal end 902 from the distal end 904. In the illustrated embodiment, this may be accomplished by engaging the drive feature 972 and rotating the shaft 970 in a direction opposite a direction in which the threads have been engaged with each other. Once the shaft 970 is backed out of the shaft opening 966, the proximal end 902 and/or distal end 904 can be separated. If the proximal end 902 and/or distal end 904 are separated after deployment of the set of proximal guide pins 928 and the set of distal guide pins 930, separation of the proximal end 902 and/or distal end 904 can permit removal of the proximal end 902 and/or distal end 904 without removing the set of proximal guide pins 928 and/or the set of distal guide pins 930. Of course, those of skill in the art will appreciate that rather than use a coupler 942, the navigation guide 900 may be removed by removing one or the other or both of the set of proximal guide pins 928 and/or the set of distal guide pins 930.	261	Added by DJM Jan 2024	1/6/24, 10:06 PM

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