Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Application	Content	Paragraph Number	Notes	Modified
		Content		Paragraph Number	Notes	Any Field
View Edit Delete	PER-10	The first metatarsal alignment feature 2820 may take the form of various devices. In one embodiment, the first metatarsal alignment feature 2820 may include the distal alignment feature 1990 and/or the distal alignment feature 2290 of a pin guide 2400 or one or more fasteners 1956 placed by a surgeon or placed using one or more of a de-rotation handle 2500 and/or alignment handle 2510. The pin guide 2400 may position a plurality of alignment pins such that the first metatarsal 230 can be rotated to align the pins and rotate the first metatarsal 230 through a desired rotation angle about the first metatarsal 230 longitudinal axis.	294	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In certain embodiments, the cut guide 2810 may be a patient specific instrument, a patient specific cut guide. In certain embodiments, the cut guide 2810 is fabricated for a particular joint, of a particular patient, and/or to address a particular condition. Various example cut guides such as cut guide 300, cut guide 700, cut guide 1043, cut guide 1200, cutting guide 1900, cut guide 2200, or the like may serve as the cut guide 2810 of the system 2800. The cut guide 2810 may include a first guide feature configured to define a first cut surface configured for resection of a first metatarsal of a patient. First slot 1960 and/or first slot 2260 may serve as one example of the first guide feature. The cut guide 2810 may include a second guide feature configured to define a second cut surface configured for resection of a medial cuneiform of a patient. Second slot 1970 and/or second slot 2270 may serve as one example of the second guide feature. The cut guide 2810 may include an inferior side comprising a bone engagement surface shaped to match a first surface of the first metatarsal and a second surface of the medial cuneiform. Inferior side 1922 and/or bone engagement surface 1924 or inferior side 2222 and/or bone engagement surface 2224 may serve as one example of the inferior side and bone engagement surface. In one embodiment, the cut guide 2810 may include a medial cuneiform alignment feature coupled to the medial cuneiform. The proximal alignment feature 1980 and/or the proximal alignment feature 2280 may serve as the medial cuneiform alignment feature. The first guide feature and/or the second guide feature of the cut guide 2810 may be configured based on patient imaging data such that fusion of the first metatarsal at the first cut surface to the medial cuneiform at the second cut surface mitigates the condition. In certain embodiments, the cut guide 2810 is fabricated for single use with a single patient and on a left or a right extremity of the patient.	293	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 28 illustrates a perspective view of an exemplary system 2800 for correcting a condition in accordance with one embodiment. The system 2800 includes a cut guide 2810, a first metatarsal alignment feature 2820, and a compressor/distractor 2830.	292	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Alternatively, or in addition, the surgeon may leave the parallel compressor/distractor 1500 connected and actively applying a compressive force to press the bones together while another kind of fastener 2710, such as a bone plate. The fastener 2710 may be deployed with one or more bone screws into the bones to connect the first metatarsal 230 to the first cuneiform 210. Advantageously, the fastener 2710 can be deployed which the bones are under active compression. This can promote osteointegration and fusion of the bones to close the joint. With the fastener 2710 deployed a surgeon may release, and remove, the parallel compressor/distractor 1500. This may complete the osteotomy procedure with the remains steps being closing the incision(s) and preparing the patient for recovery.	291	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Next, various forms of fixation may be used to complete the fusion of the two bones. FIG. 27 illustrates a perspective view of the first cuneiform and the first metatarsal of FIGS. 24A, 25A with a parallel compressor/distractor 1500 and fastener(s). In one embodiment, a surgeon may slide the cross joint guide 1604 over the fasteners 1956 of the distal alignment feature 1990/2290 and use the holes 1608 to deploy fasteners such as K-wires or bone screws across the joint to respectively, temporarily or permanently fuse the joint.	290	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Next, the surgeon may use the parallel compressor/distractor 1500 to compress the two bones together at the newly formed cut surfaces. This causes a desired rotation and translation of the first metatarsal 230 relative to the first cuneiform 210. This forces the cut surfaces (or faces) of the two bones to become parallel. Advantageously, the cut surfaces of the two bones can be forced to become parallel because the position, orientation, and angles of the fasteners 1956 of either, or both, of the proximal alignment feature 1980/2280 and distal alignment feature 1990/2290 can be predefined and customized for each patient when the cutting guide 1900/2200 is fabricated. This alignment enables parallel compression of the two bones together using the parallel compressor/distractor 1500 to provide active compression. Parallel active compression enables more effective compression of the two bones together. The parallel compressor/distractor 1500 is activated such that the first cuneiform 210 and the first metatarsal 230 are pressed together against each other.	289	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	According to certain methods, a surgeon may next distract the joint in order to prepare surfaces for fusion. The surgeon may slide holes 1502a,b over fasteners 1956 and holes 1502c,d over fasteners 1956. The surgeon activates the parallel compressor/distractor 1500 to distract the first metatarsal 230 relative to the first cuneiform 210. Connecting the parallel compressor/distractor 1500 may perform final alignment of the first cuneiform 210 and first metatarsal 230. Once distracted, the surgeon may remove intruding soft tissue and may fenestrate and/or abrade the cut surfaces of the two bones to encourage fusion and/or osteointegration.	288	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 26 illustrates a perspective view of the first cuneiform and the first metatarsal of FIGS. 24A, 25A with a compressor / distractor and cross joint guide. In the illustrated embodiment, a surgeon has removed other instruments such that fasteners 1956 of the proximal alignment feature 1980/2280 and fasteners 1956 of the distal alignment feature 1990/2290 remain in the bones. Next, the surgeon may couple an active compression instrument 2610 (which may be similar to the exemplary parallel compressor/distractor 1500 or parallel compressor/distractor 1600) to the fasteners 1956 by sliding the holes 1502a,b over the fasteners 1956 of the proximal alignment feature 1980/2280 and the holes 1502c,d over the fasteners 1956 of the distal alignment feature 1990/2290. An active compression instrument 2610 refers to any instrument that can compress two or more structures together towards each other or against a stationary object. An "active compression instrument" refers to a mechanical device, apparatus, member, object, body, component, or structure, that is organized, configured, designed, arranged, or engineered to maintain two objects in a compressed state one against the other which may enable a user to perform one or more other operations, method steps, or activities. One example of an active compression instrument is a compressor or an instrument that can function as both a compressor and a distractor. An active compression instrument 2610 may be configured to only provide a compression feature. Alternatively, or in addition, an active compression instrument 2610 may be configured to provide both a compression feature and a distraction feature. The distraction feature is a feature the distracts or separates at least two structures.	287	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 25B illustrates a perspective view of the first cuneiform and the first metatarsal of FIG. 25A with the de-rotation handle and first metatarsal rotated. Once the first metatarsal 230 has been de-rotated a surgeon may connect an alignment handle 2510 to fasteners 1956 of the proximal alignment feature 1980/2280. The alignment handle 2510 may include two proximal alignment holes 2512 and two distal alignment holes 2514. A surgeon may rotate or de-rotate the first metatarsal 230 using the de-rotation handle 2500 until the first metatarsal 230 is in a desired de-rotated/rotated position. Next, a surgeon may slide the proximal alignment holes 2512 over the fasteners 1956 of the proximal alignment feature 1980/2280. The distal alignment holes 2514 may be aligned with the proximal alignment holes 2512. Next, a surgeon may insert a fasteners 1956 (e.g., K-wire) into the distal alignment holes 2514. The fasteners 1956 of the distal alignment holes 2514 may serve as the distal alignment feature 1990/2290. Next, the osteotomy may include a final alignment and compression step.	286	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	an inferior side comprising a bone engagement surface shaped to match a first surface of a first bone and a second surface of a second bone of a joint;	322	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	a distal arm extending from the body and away from the proximal arm; and	333	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	a proximal arm extending from the body; and	332	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	4. The patient specific instrument of claim 1, wherein the body comprises:	331	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	3. The patient specific instrument of claim 1, wherein one of the first guide feature and the second guide feature comprise a position and an orientation, at least one of which is based on patient imaging data and wherein the patient imaging data is used to define a distance between at least one of a first top edge of the first guide feature and the first surface and a second top edge of the second guide feature and the second surface.	330	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	wherein the first cut surface is perpendicular to a longitudinal axis of the first bone.	329	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	wherein the second cut surface extends inferiorly away from the first cut surface at a first angle measured from the first cut surface and extends posteriorly away from the first cut surface at a second angle measured relative to the first cut surface; and	328	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	the second guide feature is configured to define a second cut surface formed by resection of the second bone;	327	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	the first guide feature is configured to define a first cut surface formed by resection of the first bone;	326	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	2. The patient specific instrument of claim 1, wherein when the bone engagement surface seats over the joint:	325	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	wherein the body is configured to seat transverse to the joint with the bone engagement surface engaging at least one of the first surface of the first bone and the second surface of the second bone.	324	Added by DJM 2 2022	2/25/22, 12:00 AM

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