Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Application	Content	Paragraph Number	Notes	Modified
		Content		Paragraph Number	Notes	Any Field
View Edit Delete	PER-10	In one embodiment, the opening 2012 and the post 2014 engage each other in a friction fit. For example, the post 2014 may slide into the second slot 1970 and the engagement member 2016 may slide into the opening 2012. In one embodiment, the engagement member 2016 may include tabs that are biased outward and greater than a diameter of the opening 2012 such that the tabs engage the opening 2012 when inserted and release the opening when the tabs are pressed together.	239	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The alignment guide 2020 includes a body 2022, an inferior end 2024, and superior end 2026 and one or more openings 2028 near the superior end 2026. The openings 2028 may be aligned. A surgeon may use the alignment guide 2020 by engaging the coupler 2010 to couple the alignment guide 2020 to the cutting guide 1900. Next, a surgeon may insert one or more K-wires through the openings. The openings 2028 and alignment guide 2020 may be configured such that K-wires within the openings extend along an anterior-posterior axis and indicate the orientation and alignment of the first cuneiform 210 and first metatarsal 230 once the osteotomy procedure is completed. A surgeon may compare this alignment with the orientation and alignment of other bones of the patient. In this manner, a surgeon can confirm that osteotomy procedure will accomplish the desired outcome once completed.	240	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Figures 22A-22H are top perspective, top, bottom, front elevation, rear elevation, right, left, and alternative top perspective, respectively, of a patient-specific cutting guide 2200 according to one embodiment. The cutting guide 2200 may be designed to facilitate resection of a first cuneiform near a distal end and a first metatarsal near a proximal end with planar cuts at the proper angles to provide dual-plane correction of the orientation of the first metatarsal relative to the first cuneiform, thereby providing correction in a lateral direction, in a plantar direction, and/or a dorsal direction.	241	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	As shown, the cutting guide 2200 may have a body 2210 with a monolithic construction and the general shape of a rectangular shape. The body 2210 includes a proximal side 2212, a distal side 2214, a medial side 2216, a lateral side 2218, a superior side 2220, and an inferior side 2222. In the illustrated embodiment, the body 2210 may also include a proximal arm 2230 that extends from the body 2210 and a distal arm 2240 that extends from the body 2210. The proximal side 2212 is the side closest to the core of the patient when the cutting guide 2200 is in use. The distal side 2214 is the side furthest from the core of the patient when the cutting guide 2200 is in use. The medial side 2216 is the side facing medially when the cutting guide 2200 is in use. The lateral side 2218 is the side facing laterally when the cutting guide 2200 is in use. The superior side 2220 is the side facing up away from the bone(s) when the cutting guide 2200 is in use. The inferior side 2222 is the side facing down, facing, and/or contacting the bone(s) (e.g., contacting a surface of one or more bones) when the cutting guide 2200 is in use.	242	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The inferior side 2222 may be custom contoured to match the shapes of one or more of the surfaces of the first cuneiform and/or the first metatarsal. In one embodiment, the inferior side 2222 may include a bone engagement surface 2224. The bone engagement surface 2224 can be shaped to match a first surface of a first bone and a second surface of a second bone of a joint.	243	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In one example, the bone engagement surface 2224 can be shaped such that the bone engagement surface 2224 matches a surface of a cuneiform bone and a surface of a metatarsal bone of a tarsometatarsal (“TMT”) joint. The bone engagement surface 2224 can be so shaped because it is fabricated from a bone model of the patient’s bones. The body 2210 is configured, designed, and/or fabricated to seat transverse to a joint (e.g., a TMT joint) with the bone engagement surface 2224 engaging a first surface of a first bone and a second surface of a second bone.	244	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Figures 22A-22H includes similar components, parts, devices, apparatus, features, and aspects as those disclosed and described in relation to Figures 19A-19H, however the difference in Figures 22A-22H is that body 2210, bone engagement surface 2224, and/or one or more arms (e.g., proximal arm 2230 and/or distal arm 2240) are configured to couple to the bones and extend transverse to the joint, at least partially, if not completely, on the dorsal sides of the bones. Accordingly, the cutting guide 2200 may be referred to as a dorsal cutting guide.	245	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In addition, the cutting guide 2200 may be configured to avoid contact with soft tissue such as nerves, tendons, blood vessels, and the like that may run along a medial and/or a lateral side of the first metatarsal 230. Accordingly, the cutting guide 2200 may be fabricated to seat transverse to the TMT joint such that the bone engagement surface contacts a dorsal surface of the a first bone (e.g., first cuneiform 210) and/or a second bone (e.g., first metatarsal 230). For example, the proximal arm 2230 and/or distal arm 2240 may be positioned more laterally than in other embodiments.	246	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 20 illustrates an example cutting guide 1900 at a particular stage in an osteotomy procedure. In one embodiment, a surgeon has formed an incision transverse to a TMT joint 2000 with a dorsal approach. In the illustrated embodiment, the cutting guide 1900 may be configured (e.g., the bone engagement surface 1924) to seat between the dorsal surface and medial surface of both the first cuneiform 210 and the first metatarsal 230. The surgeon has also formed the incision down to the cortical bone surface of the first cuneiform 210 and the first metatarsal 230. Further, the surgeon has cut, or moved to the side, soft tissue covering the cortical bone surface of the first cuneiform 210 and the first metatarsal 230 sufficient to seat the bone engagement surface 1924 onto the cortical bone surface of the first cuneiform 210 and the first metatarsal 230.	234	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In certain embodiments, the bone engagement surface 2224 may include a cuneiform apposition portion 2226 and a metatarsal apposition portion 2228. As shown, the cuneiform apposition portion 2226 may be contoured to match the contour of the surface of the first cuneiform on which it is to rest, and the metatarsal apposition portion 2228 may similarly be contoured to match the contour of the surface of the first metatarsal on which it is to rest. (See FIG. 22C) Thus, the body 2210 may have only one stable position and orientation relative to the first cuneiform and the first metatarsal during a surgical osteotomy for correcting the condition.	248	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Advantageously, the fidelity of the patient imaging data enables the bone model, preliminary cutting guide model, and patient specific instrument (e.g., patient specific cutting guide, patient specific pin guide, patient specific alignment guide, etc.) to uniquely match a particular patient. Consequently, the bone engagement surface 2224 can engage the surfaces of the bones of a joint in a single configuration. Such a close matching fit facilitates the surgical osteotomy.	249	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 22D illustrates the cutting guide 2200 from a view facing the medial side 2216. FIG. 22E illustrates the cutting guide 2200 from a view facing the lateral side 2218. In certain embodiments, the cutting guide 2200 may include one or more features that facilitate use of the cutting guide 2200 while avoiding certain soft tissue in the vicinity of a joint. For example, the medial side 2216 may include a medial superior surface 2232 and a medial inferior surface 2234 that meet at a medial edge 2236. Advantageously, the medial inferior surface 2234 may extend from inferior side 2222 to the medial edge 2236 at an angle such that the medial inferior surface 2234 does not impinge soft tissue near the joint (e.g., near a medial end of the joint). In certain embodiments, the angle may range between about 80 and 170 degrees. In another example, the lateral side 2218 may include a lateral superior surface 2242 and a lateral inferior surface 2244 that meet at a lateral edge 2246 (See FIG. 22E). Of course, the medial superior surface 2232 may extend from the superior side 2220 to the medial edge 2236 at an angle. The angle of the medial superior surface 2232 may enable use of the cutting guide 2200 in tighter openings and thus minimize the size of incisions used for a procedure.	250	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Advantageously, the lateral inferior surface 2244 may extend from inferior side 2222 to the lateral edge 2246 at an angle such that the lateral inferior surface 2244 does not impinge soft tissue near the joint (e.g., near a medial end of the joint). In certain embodiments, the angle may range between about 80 and 170 degrees. Of course, the lateral superior surface 2242 may extend from the superior side 2220 to the lateral edge 2246 at an angle. The angle of the lateral superior surface 2242 may enable use of the cutting guide 2200 in tighter openings and thus minimize the size of incisions used for a procedure.	251	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The body 2210 may further include guide features that guide a cutter to resect the first cuneiform and the first metatarsal in the manner needed to make the desired correction. For example, the guide features may be used to guide a planar cutting blade, an arcuate cutting blade, a drill or mill, a burr, and/or the like.	252	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In the embodiment of Figures 22A through 22H, the guide features may guide a reciprocating planar blade, such as that of a surgical bone saw, that forms planar cuts in the first cuneiform and the first metatarsal. Various manual or powered tools may be used to form the planar cuts. In one embodiment, a sagittal bone saw can be used. In one example, the guide features may take the form of a first slot 2260 and a second slot 2270. The first slot 2260 may include a lateral end 2262 and a medial end 2264. The second slot 2270 may include a lateral end 2272 and a medial end 2274.	253	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In one embodiment, the first slot 2260 and the second slot 2270 extend from the superior side 2220 to the inferior side 2222. In certain embodiments, the first slot 2260 may extend from near the lateral side 2218 to near the medial side 2216. In other embodiments, one of, or both of, the first slot 2260 and the second slot 2270 may extend from one of the medial side 2216 or the lateral side 2218 of the body 2210. In certain embodiments, the first slot 2260 and second slot 2270 intersect. In other embodiments, the first slot 2260 and second slot 2270 do not intersect.	254	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Thus, upon desired positioning of the cutting guide 2200, the second slot 2270 may be positioned over at least a portion of the first cuneiform to facilitate resection of the first cuneiform, while the first slot 2260 may be positioned over at least a portion of the first metatarsal to facilitate resection of the first metatarsal. In one embodiment, the second slot 2270 is positioned near the distal end of the first cuneiform and the first slot 2260 is positioned near the proximal end of the first metatarsal. The first slot 2260 and second slot 2270 together, with the bone engagement surface 2224 overlying the first cuneiform and the first metatarsal, are positioned to guide resection of the first cuneiform and the first metatarsal during a surgical osteotomy for correcting a condition.	255	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In alternative embodiments, a guide feature may be designed to guide a different type of cutter, such as a drill, mill, or side-cutting burr. In such embodiments, the guide 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 guide features may be replaced by a single guide feature sized to permit a surgeon to resect both a first cuneiform and a first metatarsal using a single cutting guide 2200.	256	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Alternatively, or in addition, in certain embodiments, one or both of, the first guide feature and second guide feature may be positioned on, or in, the body 2210 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 first guide feature and second guide feature 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 2224, a position for a first slot 2260, an orientation for a first slot 2260, a position for a second slot 2270, an orientation for a second slot 2270, as well as other features and attributes of one or more patient specific instruments that can be used in a procedure.	258	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 23 illustrates a perspective view of a first cuneiform and a first metatarsal with one embodiment of a patient-specific cutting guide positioned over a TMT joint. In the illustrated embodiment, the first guide feature may take the form of the first slot 2260 and the second guide feature may take the form of the second slot 2270. As with the embodiment of FIGS. 19A-19H and 20, the position and/or angles (e.g., orientation) of one or both of the guide features based on patient imaging data is illustrated. The first slot 2260 is oriented based on a desired angle for mitigating the condition of the patient. In one example, the first slot 2260 is angled perpendicular to a longitudinal axis 2276 of the first metatarsal 230. This orientation of the first slot 2260 enables the first cut surface to extend from the body 2210 toward the bone to form a cut surface that is also perpendicular to the longitudinal axis 2276 of one of the bones of a joint.	259	Added by DJM 2 2022	2/25/22, 12:00 AM

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