Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Application	Content	Paragraph Number	Notes	Modified
		Content		Paragraph Number	Notes	Any Field
View Edit Delete	PER-20	The reference feature facilitates moving from one coordinate system or frame of reference in a virtual environment to a position, location, frame of reference, environment, or orientation on, or in, an actual object, structure, device, apparatus, anatomical structure, or the like. Advantageously, the reference feature can coordinate objects, models, or structures in a digital or virtual model or representation with corresponding objects or structures (e.g., anatomical structures) of actual physical objects or structures. Said another way, the reference feature can serve to map from a virtual or modeled object to an actual or physical object.	172	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Advantageously, the embodiment of the present disclosure include features and aspects that assist a surgeon in locating at least one reference feature, which can then be used in one or more stages of a surgical procedure. In certain embodiments, the actual instruments fabricated using the present disclosure may include one or more references (e.g., a model references). The one or more model instruments may use the one or more references to position and/or orient the one or more model instruments such that other steps of a surgical procedure can be performed in relation to those one or more model instruments and/or model references. Certain model references may key off or related to anatomical references of modeled anatomical body parts. The reference feature(s) correspond to the model references and together enable a surgeon to identify reference features on actual anatomy of a patient for a surgical procedure.	173	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	FIGS. 6A and 6B illustrate a couple of examples of a mapping between a virtual model and physical anatomy of a patient’s foot. FIG. 6A illustrates a model or virtual pane 610 and an actual or physical pane 620.	174	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The virtual pane 610 illustrates a view and/or representation of one or more models of bones of a specific patient. Models of soft tissue are not shown for clarity and to facilitate the description. Alternatively, or in addition, as explained above, models of soft tissue are not as reliable as desired for use in planning the surgical procedure. The virtual pane 610 includes a bone model 404 that includes a model of a medial cuneiform 202, a model of a first metatarsal 208, a model of a second metatarsal 210, etc. Virtual pane 610 illustrates that the foot 200 has a deformity. Specifically, the first metatarsal 208 extends more medial than desired; the first metatarsal 208 is not substantially parallel to the second metatarsal 210.	175	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The physical pane 620 illustrates a view of one or more actual bones of a specific patient. Soft tissue is not shown for clarity and to facilitate the description. The physical pane 620 illustrates actual bones of the same patient used to create the models of virtual pane 610. Physical pane 620 shows a medial cuneiform 202, a first metatarsal 208, a second metatarsal 210, etc. Physical pane 620 shows the patient’s foot 200 has a deformity. Specifically, the first metatarsal 208 extends more medial than desired; the first metatarsal 208 is not substantially parallel to the second metatarsal 210.	176	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The virtual pane 630, like virtual pane 610 illustrates a view and/or representation of one or more models of bones of this specific patient. Models of soft tissue are not shown. The virtual pane 630 includes the same models as virtual pane 610 and illustrates the foot 200 after the deformity has been addressed. Specifically, the model of the first metatarsal 208 extends more parallel to the model of the second metatarsal 210 than before.	177	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The physical pane 640, like physical pane 620 illustrates a view of the same actual bones as physical pane 620. Physical pane 640 shows the patient’s foot 200 after the deformity has been addressed. Specifically, the first metatarsal 208 extends more parallel to the second metatarsal 210 than before.	178	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In this example, a surgeon has decided to do an arthrodesis procedure on the 1st TMT joint (between the medial cuneiform 202 and the first metatarsal 208). In virtual pane 610, a surgeon or other user may identify an axis 612 between a model of the medial cuneiform 202 and a model of the first metatarsal 208 which the user wants to use as a reference for checking the outcome of a surgical procedure near the final steps of the procedure. It should be noted that rather than aligning the axis 612 with a long axis of the first metatarsal 208, the axis 612 in virtual pane 610 extends more medial. In one embodiment, this difference may be because the surgeon intends to reorient the first metatarsal 208 and rotate the first metatarsal 208 such that sesamoids 258 are directed more plantar once the surgical procedure is completed. Virtual pane 630 illustrates that once the procedure is completed the axis 612 will align with the long axis of the model of the first metatarsal 208 and the model of the first metatarsal 208 will be substantially parallel to the model of the second metatarsal 210.	179	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	FIGS. 6A and 6B illustrate one example of embodiment of one or more instruments that can be used to assist a surgeon in performing the surgery in a manner that most closely matches the desired or planned surgery set out using models of the bones and/or models of instruments. In particular, the present disclosure in this example provides one or more instruments that bridge the divide between the virtual environment and the physical environment that the surgeon will work with during the surgery.	180	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Advantageously, the present disclosure provides a patient-specific instrument model 462 that can be readily fabricated to provide a patient-specific instrument 406. In this example, a model navigation guide 616 and corresponding actual patient-specific navigation guide 618 and a model positioning guide 626 and corresponding actual patient-specific positioning guide 628 are illustrated and provided. Advantageously, the patient-specific instrument model 462 and patient-specific instrument 406 share one or more common features and/or aspects that enable the patient-specific instrument 406 to serve as a navigation guide that helps a surgeon locate a desired position and/or orientation for one or more instruments in relation to anatomy of a patient during a surgical procedure.	181	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In the illustrated embodiment, the patient-specific instrument model 462 includes one or more markers 614. The markers 614 serve to identify a location for a reference feature. In one embodiment, markers 614 may be a form of fiducials. FIG. 6A and 6B illustrate where on a model of a patient’s anatomy a marker is in panes 610/630 in relation to where those same markers will be on actual anatomy in panes 620/640.	182	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Those of skill in the art will appreciate that the markers 614 may be implemented using a variety of different structures. In one embodiment, pin locations or holes for temporary fasteners, such as K-wires may be defined in a model navigation guide 616 and/or model positioning guide 626 that serve as markers 614 or model references. In addition, pin locations or holes for temporary fasteners may be defined in an actual patient-specific navigation guide 618 and/or actual patient-specific positioning guide 628 that serve as markers 614 or reference features. Alternatively, or in addition, the guide pins (e.g., fasteners) within the holes may serves as reference features.	183	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Alternatively, or in addition, a patient-specific instrument model 462 may include other features that are part of, or cooperate with a model reference or anatomical reference. In one embodiment, the model instrument may include a feature such as a tissue engagement surface (e.g., a bone engagement surface) or a registration key that is configured to engage with the tissue in a single position and/or orientation. Thus, in certain embodiments, holes in a patient-specific instrument model 462 and/or other features such as tissue engagement surface can serve as a model reference or marker for a reference feature. Advantageously, the corresponding patient-specific instrument 406 includes the marker and/or other patient-specific features that ensure a surgeon positions the instrument in the desired location in relation to the actual anatomy of the patient during the surgical procedure.	184	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In the illustrated embodiment, of FIGS. 6A and 6B, the markers 614 may be guide pin holes for guide pins that may serve as reference features for at least an initial step in a surgical procedure and/or may serve as references for one or more subsequent steps in the surgical procedure. those of skill in the art will appreciate that other embodiments of markers 614 may be used within the scope of the present disclosure. FIGS. 6A and 6B that with the patient-specific features and/or markers 614 of the present disclosure a surgeon can position the actual patient-specific navigation guide 618 and/or actual patient-specific positioning guide 628 in desired positions on the anatomy. With the instruments in position ( a position that corresponds to, and/or matches, the position of the model instrument in the model), a surgeon can mark, identify, form, or create the reference features that successfully map model references to anatomical references on a patient.	185	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	FIG. 7 illustrates an exemplary system 700 for remediating a condition present in a patient’s foot, according to one embodiment. The system 700 can include one or more fasteners 710, one or more resection guides 720, and one or more complementary components 730. While a system 700 can be used for a variety of procedures, one or more features, components, and/or aspects of the system 700 may be particularly suited for one or more osteotomies on one or more bones of a structure such as a patient’s foot, ankle, wrist, hand, shoulder, or the like.	186	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In certain embodiments, the one or more fasteners 710 can include one or more permanent fasteners and/or one or more temporary fasteners. Typically, the fasteners 710 may be used during a variety of different steps of a procedure. Temporary fasteners are often used because they can securely hold bone or parts/fragments of bones while steps of the procedure are conducted. A common temporary fastener that can be used with system 700 is a K-wire, also referred to as a pin, guide pin, and/or anchor pin. Permanent fasteners 710 such as bone screws, bone staples, sutures, tethers or the like may also be used in a surgical procedure.	187	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The one or more resection guides 720 assist a surgeon in performing different resection or dissection steps for an osteotomy or other procedure. In certain embodiments, a resection guide 720 includes one or more resection features 722 and one or more bone attachment features 724. The resection features 722 can take a variety of forms and/or embodiments. In one embodiment, the resection features 722 take the form of a cut channel or slot or other opening.	188	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The resection features 722 provide a guide for a surgeon using a cutting tool to resect a bone, one or more bones, or other tissues of a patient. In certain embodiments, the resection features 722 may guide a surgeon in performing a resection, and osteotomy, and/or a dissection.	189	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Similarly, the bone attachment features 724 can take a variety of forms and/or embodiments. The bone attachment features 724 may serve to secure the resection guide 720 and/or other instrumentation to one or more bones and/or one or more other structures. Often, a bone attachment feature 724 can take the form of a hole in and/or through the resection guide 720 together with a temporary fastener such as a K-wire, pin, or guide pin.	190	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The bone attachment features 724 facilitate attachment (at least temporarily) of a resection guide 720 to one or more bones, or bone fragments, of a patient. The bone attachment features 724 may include any of a wide variety of fasteners or structures including, but not limited to, holes, spikes, prongs, screws, fastening devices, and/or the like. Effective connection of the resection guide 720 to one or more bones across a joint and/or to one or more bones can ensure that cut surfaces are formed in desired locations and orientations and mitigate removal of hard tissue and/or soft tissue in undesired locations and/or orientations.	191	Added by DJM Jan 2024	1/6/24, 10:06 PM

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