Dave's PCF WIP: Paragraphs

Paragraphs

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View Edit Delete	PER-10	FIG. 23 illustrates an example cutting guide 2200 seated transverse to a tarsometatarsal (“TMT”) joint 2000. The TMT joint 2000 includes a lateral end 2002 and a medial end 2004. In certain embodiments, such as the illustrated embodiment, the body 2210 is configured to extend between the lateral end 2002 and the medial end 2004. In this manner, the first slot 2260 and second slot 2270 extend along the TMT joint 2000 in a lateral medial direction and are long enough that a surgeon can readily resect the respective ends of the respective bones of the joint. In addition, the proximal arm 2230 and the distal arm 2240 may be aligned with each other. In one embodiment, the proximal arm 2230 and distal arm 2240 may extend proximal to the lateral side 2218 and/or proximal to the lateral end 2002 of the joint (e.g., TMT joint 2000).	270	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Advantageously, the cutting guide 2200 can be used with patients that have smaller bones and joints such as children or female patients. The cutting guide 2200 fits directly on the dorsal surfaces of the bones of the joint. This placement can avoid contact with soft tissues that may run along the medial and/or lateral surfaces of the bones of the joint.	271	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 23 illustrates that the cutting guide 2200 can be secured to the bones using the proximal bone attachment feature 2252 and/or distal bone attachment feature 2254 each of which may include two or more fasteners 1956. In certain embodiments, the fasteners 1956 of the proximal bone attachment feature 2252 are aligned with each other and perpendicular to the second slot 2270. The fasteners 1956 of the distal bone attachment feature 2254 are aligned with each other and perpendicular to the first slot 2260. The fit of the bone engagement surface 2224 to the surfaces (dorsal in this embodiment) of the bones helps to secure the cutting guide 2200 in place and ensure that resection of the bones using the first slot 2260 and second slot 2270 forms the desired cut surfaces for the procedure.	272	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In the illustrated embodiment, the second slot 2270 is positioned and oriented based on a desired angle for mitigating the condition of the patient. In the illustrated embodiment, the orientation of the second slot 2270 can be described in reference to a first angle A and a second angle B, just as those angles are described above in relation to FIG. 19D and 19H.	260	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	It should be noted that the cutting guide 1900 and/or cutting guide 2200 may be configured to engage with a dorsal surface of one bone (e.g., a first cuneiform 210) and a lateral surface of a second bone (e.g., a first metatarsal 230) of a joint (e.g., TMT joint 2000). For example, where the patient has a hallux valgus condition, the first metatarsal 230 may have rotated about its longitudinal axis 1976/2276 such that the lateral surface of the first metatarsal 230 faces dorsal. Advantageously, the present disclosure accounts for this and the cutting guide 1900/2200 is configured to contact a dorsal surface on one bone and a lateral surface of the second bone (or proximal surface if the bone is rotated in the other direction). Furthermore, the proximal alignment feature 1980/2280 may engage with a dorsal surface of a proximal bone and the distal alignment feature 1990/2290 may engage with a dorsal surface of a distal bone, even though the distal bone has rotated.	274	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Referring to FIGS. 20 and 23, in the illustrated embodiments, the proximal alignment feature 1980/2280 and distal alignment feature 1990/2290 may be in separate devices rather than being combined in a single device. FIGS. 20 and 23 show the proximal alignment feature 1980/2280 as part of the cutting guide 1900/2200. FIG. 24A illustrates a distal alignment feature 1990/2290 that is part of a separate device. FIG. 24A illustrates a perspective view of the first cuneiform and the first metatarsal of FIGS. 20, 23 with one embodiment of a pin guide 2400 that includes a distal alignment feature 1990/2290.	275	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 24A illustrates a perspective view of the first cuneiform 210 and the first metatarsal 230 of FIG. 23 after resection of the bones. After resection, a surgeon remove the cutting guide 1900/2200 by sliding it off of the fasteners 1956 and keep the fasteners 1956 connected to the bones. The fasteners 1956 on the first cuneiform 210 can serve as a proximal alignment feature 1980/2280. The fasteners 1956 on the first metatarsal 230 can serve as a guide for a distal alignment feature 1990/2290. For example, the surgeon can slide pin guide 2400 over the fasteners 1956 on the first metatarsal 230. The pin guide 2400 can then identify where to position the distal alignment feature 1990/2290.	276	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The pin guide 2400 includes a bone attachment feature 2410 realized by a pair of holes 2412 that extend from a superior surface to an inferior surface. Advantageously, the holes 2412 can engage with the fasteners 1956 (which have remained in the bone) used with the cutting guide 1900/2200.	277	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The pin guide 2400 also includes a distal alignment feature 1990/2290. In certain embodiments, the distal alignment feature 1990/2290 is offset from the bone attachment feature 2410. In certain embodiments, the bone attachment feature 2410 is offset from the bone attachment feature 2410 by a certain distance that corresponds to a number of degrees of rotation of the first metatarsal 230 from an original position to a new positioned after rotating the first metatarsal 230 about its longitudinal axis 1976/2276. The first metatarsal 230 can be rotated a certain number of degrees about its longitudinal axis 1976/2276 in either a clockwise or a counterclockwise direction. Typically, the first metatarsal 230 is rotated counterclockwise to address a condition such as a hallux valgus condition.	278	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 24B illustrates a diagram representative of a cross-sectional view of a first metatarsal 230 from a proximal base (represented as a circle) looking towards the distal head. FIG. 24B illustrates the relationship between the bone attachment feature 2410 and the distal alignment feature 1990/2290. Angle C represents the number of degrees between the first positioned and the second position that the bone will be rotated to once rotated about the longitudinal axis 1976/2276. In certain embodiments, angle C may range between about 0 and about 35 degrees.	279	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Referring now to FIG. 24A, a surgeon may not know per-operatively how much rotation is needed or can be achieved given the condition and anatomy of the patient. Accordingly, the present disclosure may include a number of pin guides 2400 each with a different number of degrees of correction built into the placement of the distal alignment feature 1990/2290 relative to the bone attachment feature 2410. Examples include a 25 degree pin guide 2400, 30 degree pin guide 2400, 35 degree pin guide 2400, 40 degree pin guide 2400, 10 degree pin guide 2400, 15 degree pin guide 2400, and the like. Each pin guide 2400 that provides a different number of degrees of rotation may include a marking that identifies the number of degrees (e.g., “25”, “30”, etc.). Alternatively, or in addition, certain pin guide 2400 may be configured for use on a joint of a left foot versus a right foot. Similarly, such pin guide 2400 may include an indicator of which foot the guide is to be used with (e.g., “Left”, “Right”). Those of skill in the art will appreciate that the degrees for the pin guide 2400 may range from about 2 degrees to about 100 degrees.	280	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In the illustrated embodiment, the bone attachment feature 2410 is perpendicular to the first slot 1960/2260 and parallel to the distal alignment feature 1990/2290 that can be coupled to the first metatarsal 230.	281	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In one embodiment, after a surgeon selects that desired amount of offset by choosing a pin guide 2400 with a desired number of degrees, the surgeon positions the selected pin guide 2400 on the first metatarsal 230 by sliding the holes 2412 over the fasteners 1956. Placement of the pin guide 2400 positions the distal alignment feature 1990/2290 for subsequent rotation of the bone. Next, a surgeon may insert two fasteners 1956 into holes of the distal alignment feature 1990/2290. The fasteners 1956 may mark the position for alignment and sit securely in the bone.	282	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Next a surgeon may de-rotate or rotate the first metatarsal 230 for subsequent fusion to the first cuneiform 210. De-rotation refers to rotation of the first metatarsal 230 about the longitudinal axis 1976/2276 such that the first metatarsal 230 assumes a position before the condition presented, for example a hallux valgus condition. As noted de-rotation may mean rotating the first metatarsal 230 counterclockwise.	283	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 24C shows one way de-rotation may be performed. FIG. 24C illustrates a perspective view of the first cuneiform and the first metatarsal of FIG. 24A with a pin guide connected. A surgeon may use various ways, devices, or methods to de-rotate the first metatarsal 230. In one embodiment, the pin guide 2400 may include a coupler, such as a threaded hole 2414 configured to thread onto an end of a handle 2416. A surgeon may connect the handle 2416 to the pin guide 2400 by way of the threaded hole 2414. A surgeon can then use the handle 2416 to guide and rotate or de-rotate the first metatarsal 230 into a desired position. In the illustrated embodiment, the surgeon may de-rotate the first metatarsal 230 until the distal alignment feature 1990/2290 substantially aligns with the proximal alignment feature 1980/2280. Alternatively, or in addition, the surgeon may rotate the first metatarsal 230 using fasteners 1956 of the distal alignment feature 1990/2290 and/or the bone attachment feature 2410.	284	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In the illustrated embodiment, the body 2210 is configured to reside on the dorsal surfaces of the first cuneiform and the first metatarsal to provide proper alignment of the body 2210 with the metatarsocuneiform joint (e.g., the joint between the first metatarsal and the medial cuneiform bone, aka a TMT joint). In another embodiment, the body 2210 is configured to reside or sit between the medial surfaces and the dorsal surfaces for an osteotomy.	247	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	A surgeon has deployed two or more fasteners 1956 (e.g., K-wires) through the holes 1950 of the proximal bone attachment feature 1952 and the distal bone attachment feature 1954. In certain embodiments, the distal bone attachment feature 1954 and/or the proximal bone attachment feature 1952 can include an additional hole 1958 for another fastener 1956. The additional hole 1958 and fastener 1956 can help keep the cutting guide 1900 in place during resection and alignment operations. In certain embodiments, the additional hole 1958 is aligned with another two holes 1950 of the distal arm 1940 but need not be aligned.	235	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Next, a surgeon can resect a distal articular surface of the first cuneiform 210 and a proximal articular surface of the first metatarsal 230 by way of the second slot 1970 and the first slot 1960. After resection, the distal end of the first cuneiform 210 includes a planar cut surface and the proximal end of the first metatarsal 230 includes a planar cut surface. FIG. 20 illustrates that the bone engagement surface 1924 conforms to the surface of the two bones (e.g., first cuneiform 210 and first metatarsal 230).	236	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIGS. 21A, 21B illustrate a perspective view of a first cuneiform and a first metatarsal with one embodiment of a patient-specific cutting guide. Prior to resection completed in the illustrated stage of FIG. 20, a surgeon may desire to check or confirm that the desired cutting guide is being used and that a selected cutting guide will provide a desired alignment between the bones of the foot after the resection and fixation steps.	237	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Accordingly, in the illustrated embodiment, the cutting guide 1900 may include one member of a coupler 2010 configured to engage a corresponding member of the coupler coupled to an alignment guide 2020. Those of skill in the art appreciate that various designs of a coupler may be used. In the illustrated embodiment, the coupler 2010 includes an opening 2012 (See FIG. 20) that may extend from the superior side 1920 into the body 1910 through to the inferior side 1922 and a post 2014. In one embodiment, the opening 2012 may include one of the slots, such as second slot 1970. The post 2014 may include an engagement member 2016.	238	Added by DJM 2 2022	2/25/22, 12:00 AM

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