Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Application	Content	Paragraph Number	Notes	Modified
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View Edit Delete	PER-20	In the illustrated embodiment, system 800 includes one or more guide pins, pins, or k-wires 918a, one or more staples 918b, one or more bone screws (not shown), and one or more bone plates 918c. Certain fasteners 918 may be used for temporary fixation while others may be used for permanent fixation. In one embodiment, the fasteners 918 are configured to single use. In one embodiment, the fasteners 918 may be provided in a surgical kit and a surgeon may choose which fasteners to use during the procedure. Alternatively, or in addition, the precision and accuracy of the present disclosure may enable a surgeon to select specific fasteners 918 to use as part of planning the surgical procedure. For example, a surgeon may choose a specific size and configuration of bone plate(s) 918c to be used.	212	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In the illustrated embodiment, two separate resection guides, a proximal resection guide 820a and a distal resection guide 820b may be used. While those of skill in the art will appreciate that a single resection guide 820 can be used for an osteotomy of a cuneiform and a metatarsal, using two separate resection guides can provide certain advantages. As mentioned herein, modeling of hard tissue is highly accurate and precise while modeling of soft tissue is less predictable. Consequently, a surgeon may not know with sufficient certainty how soft tissue will respond to steps of a surgical procedure. Specifically, the surgeon may not know now much translation and/or rotation of tissues such as bones the soft tissue will permit until the surgeon is performing the surgery.	213	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Advantageously, using two separate resection guides can enable a surgeon to adapt intraoperatively to the amount of rotation and/or translation the soft tissue will permit. Specifically, one resection guide may include a resection feature with a first angle for correction, a second resection guide may include a resection feature with a second angle for correction greater than the first, a third resection guide may include a resection feature with a third angle for correction greater than the second, and so forth. These different resection guides may be part of a kit available to the surgeon during the surgery. In this manner, a surgeon can choose a resection guide with a preferred angle for correction during the surgery.	214	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In certain embodiments, both a proximal resection guide 820a and a distal resection guide 820b can include a resection feature that is angled at an angle that is not 90 degrees with respect to a long axis of the bone being cut. Alternatively, or in addition, only one of the resection guides 820 may include a resection feature that is angled at an angle that is not 90 degrees with respect to a long axis of the bone being cut and the other resection guide 820 may include a resection feature that is angled at an angle that is 90 degrees with respect to a long axis of the bone being cut. In certain embodiments, using a resection guide 820 with a resection feature that is angled 90 degrees relative to a long axis of the bone being cut can enable a surgeon to make an easier osteotomy of a bone using the resection guide 820. In addition, in certain embodiments, the osteotomy may be more precise and more accurate than using a resection guide 820 with a resection feature that is not angled 90 degrees relative to a long axis of the bone being cut.	215	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Either or both of the resection guides 820 may be a custom patient-specific resection guides made for a particular patient and/or for a particular surgical procedure. Various aspects of the resection guides 820 may be patient-specific, including, but not limited to, an angle and/or orientation for a resection feature of the resection guide 820, a position of the resection feature, a depth of the resection feature, a size of the resection guide 820, a configuration and/or composition of a bone contacting surface such as a bone engagement surface of the resection guide 820, and the like.	216	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In the illustrated embodiment, the resection guides 620 are for one or more osteotomies at a TMT joint between a metatarsal and a cuneiform. The system 800 illustrates alternative embodiments of different components to show that each part of the system 800 can be custom designed based on the needs of the patient, the type of surgical procedure, and/or the preferences of the surgeon. Advantageously, in certain embodiments, practically every aspect of the features, aspects, and/or attributes of the system 800 can be specified and/or ordered.	217	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Different aspects and/or embodiments of the components of the system 800 are described in more detail herein. In one embodiment, the system 800 includes a set of proximal guide pins 918a, a set of distal guide pins 918a, a navigation guide 840, a proximal resection guide 820a, a distal resection guide 820b, and a positioning guide 880.	218	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	FIG. 9A illustrates a top perspective view from a medial side of a navigation guide 900 according to one embodiment. FIG. 9B illustrates a top perspective view from a lateral side of the navigation guide 900 according to one embodiment. FIG. 9C illustrates a bottom perspective view from an inferior side of the navigation guide 900 according to one embodiment.	219	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The navigation guide 900 can be configured to position one or more temporary fasteners 918a (e.g., K-wires) for use in a procedure. Advantageously, in certain embodiments, the navigation guide 900 can include one or more features that facilitate proper positioning/registering of the navigation guide 900 to a desired location on one or more bones and/or transverse to a joint and thereby map from a virtual environment of models to a physical environment of a patient’s anatomy for a surgical procedure.	220	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The navigation guide 900 includes a proximal end 902, a distal end 904, with a body 906 between them. In one embodiment, The body 906 includes a proximal side 908, a distal side 910, a medial side 912, a lateral side 914, a superior side 916, and an inferior side 918. The proximal side 908 is the side closest to the core of the patient when the navigation guide 900 is in use. The distal side 910 is the side furthest from the core of the patient when the navigation guide 900 is in use. The medial side 912 is the side facing medially when the navigation guide 900 is in use. The lateral side 914 is the side facing laterally when the navigation guide 900 is in use. The superior side 916 is the side facing up away from the bone(s) when the navigation guide 900 is in use. The inferior side 918 is the side facing down, facing, and/or contacting the bone(s) (e.g., contacting a surface of one or more bones) when the navigation guide 900 is in use.	221	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The navigation guide 900 may also include at least one marker 920 and a bone engagement surface 922. The marker 920 is a structure of the navigation guide 900 that facilitates translating features, aspects, structures, and/or other aspects of a virtual environment to a physical environment for a surgical procedure. In particular, the marker 920 identifies at least one location for a reference feature that can provide a reliable reference in the physical environment that maps or corresponds to the position and/or frame of reference in the virtual environment. In the illustrated embodiment, the marker 920 identifies a location for a reference feature that corresponds to a model reference of a bone (both a model bone and a physical bone) of a patient’s foot.	222	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In the illustrated embodiment, the marker 920 takes the form of a set of holes that extend from the superior side 916 to the inferior side 918 of the body 906. Specifically, in the illustrated embodiment, the marker 920 includes a set of proximal holes 924 and a set of distal holes 926. The angle and/or orientation of the set of proximal holes 924 and/or set of distal holes 926 extend through the body 906 may be patient-specific. In certain embodiments, the set of proximal holes 924 are configured to receive a set of proximal guide pins 928 and/or the set of distal holes 926 are configured to receive a set of distal guide pins 930. In the illustrated embodiment, the set of proximal holes 924 and/or set of distal holes 926 includes holes for two proximal guide pins 928 and holes for two distal guide pins 930 because use of two guide pins can prevent rotation of instruments that may slide over and/or anchor to the guide pins. Those of skill in the art will appreciate that where a set of structures is described herein this can include zero, one, two, three or more of the particular structure.	223	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 marker 920 may be used to accept guide pins or may be used in other ways to identify reference features. In one embodiment, a marker 920 may be implemented as holes and those holes may be used as guides for a surgeon to drill holes, tunnels, or other openings in one or more bones of patient. The holes formed in the anatomy of the patient may then serve as reference features for a surgical procedure. In still another embodiment, the marker 920 may be a structure made from a material that is detectable by sensors on a surgical assistant such as a robotic surgical device. For example, the marker 920 may be magnetic and a robotic surgical device may sense the marker 920 and use the marker 920 to deploy guide pins or form holes in anatomy of a patient.	224	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	It should be noted that that marker 920, in certain embodiments, can include the set of proximal holes 924, the set of distal holes 926, the set of proximal guide pins 928, and/or the set of distal guide pins 930, each individually or in combination with one or more of the others. In one embodiment, the marker 920 is the set of proximal holes 924 and the set of distal holes 926. In another embodiment, the marker 920 is the set of proximal holes 924 and the set of proximal guide pins 928. In another embodiment, the marker 920 is the set of distal holes 926 and the set of distal guide pins 930. Alternatively, or in addition, the reference feature may include the set of proximal guide pins 928 and/or the set of distal guide pins 930, each individually or in combination with each other.	225	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Advantageously, the marker 920 provides a convenient way for a surgeon to position and/or identify where one or more reference features are or should be with respect to anatomy of a patient to accurately map the virtual environment (model bones, model instruments, and the like) to the physical environment (a patient’s bones, physical instruments, and the like). In the illustrated embodiment, the reference feature or reference features may be one of the sets of a set of proximal guide pins 928 and/or a set of distal guide pins 930 deployed in one or more bones of the patient.	226	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The present disclosure enables a surgeon to accurately position the navigation guide 900 which includes the marker(s) 920 and the marker(s) 920 enable a surgeon to accurately deploy the set of proximal guide pins 928 and/or set of distal guide pins 930 which can serve as reference features for a surgical procedure. In this manner, the marker 920 serves a similar role to a fiducial used in other surgical procedures or contexts. Consequently, the navigation guide 900 can serve as a useful tool for a surgeon to ensure that their actions in the physical environment will match those prepared and/or preplanned in a virtual environment or model environment. The reference features serve as valuable resources and/or references for one or more steps of a surgical procedure.	227	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In addition, the navigation guide 900 can include a variety of features, structures, and/or aspects that can serve or facilitate accurately positioning the navigation guide 900 with respect to anatomy of a patient. In one embodiment, a navigation guide 900 includes a bone engagement surface 922 configured to register to an anatomical structure of one or more bones, the bone engagement surface defined based on medical imaging taken of the one or more bones. Alternatively, or in addition, the navigation guide 900 may include a registration key and/or one or more bone engagement openings.	228	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The bone engagement surface 922 can be shaped to match a first surface of a first bone and a second surface of a second bone of a joint. In one embodiment, the bone engagement surface 922 may include a custom contoured surface of the inferior side 918 to match the shapes of one or more of the surfaces of one or more bones. In the illustrated embodiment, the bone engagement surface 922 may be configured to conform to the surface(s) of a medial cuneiform 202 and/or a first metatarsal 208.	229	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In one embodiment, the bone engagement surface 922 may have a cuneiform apposition portion 932 shaped to lie against a surface (such as a dorsal surface) of the medial cuneiform 202, and a metatarsal apposition portion 934 shaped to lie against a surface (such as a dorsal surface) of the first metatarsal 208. As illustrated, the cuneiform apposition portion 932 may be contoured to match the contour of the dorsal surface of the cuneiform on which it is to rest, and the metatarsal apposition portion 934 may similarly be contoured to match the contour of the dorsal surface of the metatarsal on which it is to rest. Thus, the navigation guide 900 may have only one stable position and orientation relative to the cuneiform and the metatarsal. Alternatively, or in addition, the cuneiform apposition portion 932 may be contoured to match the contour of a surface that is between the dorsal surface and a medial or lateral surface and/or the surface includes at least a portion of the dorsal surface of the cuneiform on which it is to rest, and the metatarsal apposition portion 934 may similarly be contoured to match the contour of a surface that is between the dorsal surface and a medial or lateral surface and/or the surface includes at least a portion of the dorsal surface of the metatarsal.	230	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In one example, the bone engagement surface 922 can be shaped such that the bone engagement surface 922 matches a surface of a cuneiform bone and a surface of a metatarsal bone of a tarsometatarsal (“TMT”) joint. The bone engagement surface 922 can be so shaped because it is fabricated from a bone model of the patient’s bones. The body 906 is configured, designed, and/or fabricated to seat transverse to a joint (e.g., a TMT joint) with the bone engagement surface 922 engaging a first surface of a first bone and a second surface of a second bone.	231	Added by DJM Jan 2024	1/6/24, 10:06 PM

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