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 230 may further be offset in a plantar direction 280 or in a dorsal direction 290, relative to the remainder of the foot 200. Accordingly, the orientation of the first metatarsal 230 may need to be adjusted to move the distal end 250 in the lateral direction 260 and in the plantar direction 280 and/or in the dorsal direction 290.	83	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Every deformity is different; accordingly, the degree of angular adjustment needed in each direction may be different for every patient. Use of a patient-specific cutting guide may help the surgeon obtain the optimal realignment in the lateral direction 260 and in the plantar direction 280 or the dorsal direction 290. Conversely, use of one of several differently-sized cutting guides may provide only approximate correction, as the surgeon may not have a guide that precisely matches the correction needed for the foot 200, and must thus choose the cutting guide that most closely provides the desired correction. Such differently sized cutting guides would not be contoured to fit the first cuneiform 210 or the first metatarsal 230, thus introducing additional potential for error as the surgeon must properly align the selected cutting guide.	84	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Thus, providing a patient-specific cutting guide may provide unique benefits. Specifically, the patient-specific cutting guide may provide precise correction of the deformity present in the foot 200 and may also reduce the likelihood of improper correction due to misalignment of the cutting guide on the foot 200. The optimal cut provided by such a cutting guide may further reduce the likelihood that additional procedures, such as attachment of the first metatarsal 230 to the second metatarsal 240 to each other with screws or the like, will be needed to provide the desired correction. Any such additional procedure carries its own added surgical burden and risk of failure. Thus, the use of patient-specific instrumentation may shorten surgery, accelerate recovery, and reduce the risk of complications.	85	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Figures 3A, 3B, 3C, and 3D are top perspective, alternative top perspective, front elevation, and bottom perspective views, respectively, of a patient-specific cutting guide, or cutting guide 300, according to one embodiment. The cutting guide 300 may be designed to facilitate resection of the first cuneiform 210 and the first metatarsal 230 with planar cuts at the proper angles to provide dual-plane correction of the orientation of the first metatarsal 230, thereby providing correction in the lateral direction 260 and in the plantar direction 280 or the dorsal direction 290.	86	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	As shown, the cutting guide 300 may have a body 310 with a monolithic construction and the general shape of a rectangular prism. The cutting guide 300 may further have a joint alignment feature that helps align the body 310 with the metatarsocuneiform joint between the first cuneiform 210 and the first metatarsal 230. The joint alignment feature may consist of a joint probe 320 that extends from the body 310 and has a blade-like shape. The body 310 may reside on the dorsal surfaces of the first cuneiform 210 and the first metatarsal 230, while the joint probe 320 may protrude into the metatarsocuneiform joint between the first cuneiform 210 and the first metatarsal 230 to provide proper alignment of the body 310 with the metatarsocuneiform joint.	87	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The body 310 may have a bone facing side 330 that, upon attachment of the body 310 to the first cuneiform 210 and the first metatarsal 230, is to face toward the first cuneiform 210 and the first metatarsal 230. The body 310 may also have an outward-facing side 332 that, upon attachment of the body 310 to the first cuneiform 210 and the first metatarsal 230, faces outward, away from the first cuneiform 210 and the first metatarsal 230. Further, the body 310 may have one or more bone attachment features that facilitate attachment of the body 310 to the first cuneiform 210 and/or the first metatarsal 230. Such bone attachment features may comprise any of a wide variety of holes, spikes, fastening devices, and/or the like. As embodied in Figures 3A through 3D, the bone attachment features may take the form of holes 340 that extend from the bone facing side 330 to the outward-facing side 332 and/or one or more fixation devices. The holes 340 may be shaped to accommodate pins, K-wires, and/or other elongated bone fixation elements that can be anchored in the first cuneiform 210 and/or the first metatarsal 230 to keep the cutting guide 300 in place.	88	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The bone facing side 330 may be custom contoured to match the shapes of the first cuneiform 210 and/or the first metatarsal 230. As embodied in Figures 3A through 3D, the bone facing side 330 may have a cuneiform apposition portion 342 shaped to lie against the dorsal surface of the first cuneiform 210, and a metatarsal apposition portion 344 shaped to lie against the dorsal surface of the first metatarsal 230. As shown, the cuneiform apposition portion 342 may be contoured to match the contour of the dorsal surface of the first cuneiform 210 on which it is to rest, and the metatarsal apposition portion 344 may similarly be contoured to match the contour of the dorsal surface of the first metatarsal 230 on which it is to rest. Thus, the body 310 may have only one stable position and orientation relative to the first cuneiform 210 and the first metatarsal 230.	89	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Generation of the contours of the cuneiform apposition portion 342 and the metatarsal apposition portion 344 may be performed relative easily in various CAD programs. In some embodiments, the shapes of the corresponding dorsal surfaces of the first cuneiform 210 and the first metatarsal 230 may be obtained directly from the CAD models and/or CT scan data, and simply copied onto the model for the body 310 of the cutting guide 300. Various operations may be used to copy surfaces from one object to another. Additionally or alternatively, various Boolean operations, such as a Boolean subtraction operation, may be used to remove material from a model for the body 310 with a shape that matches the dorsal surfaces of the first cuneiform 210 and the first metatarsal 230.	90	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The body 310 may further have guide features that guide a cutter to resect the first cuneiform 210 and the first metatarsal 230 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.	91	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In the embodiment of Figures 3A through 3D, 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 210 and the first metatarsal 230. Thus, the guide features may take the form of a first slot 350 and a second slot 352, which may be positioned toward the center of the body 310, on opposite sides of the joint probe 320. Thus, upon proper positioning of the cutting guide 300, the first slot 350 may be positioned over the first cuneiform 210 to facilitate resection of the first cuneiform 210, while the second slot 352 may be positioned over the first metatarsal 230 to facilitate resection of the first metatarsal 230.	92	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Returning to Figures 3A through 3D, the body 310 may further have features that facilitate proper positioning of the cutting guide 300 on the first cuneiform 210 and the first metatarsal 230. More specifically, the body 310 may have a first bone indicator 360 with the text “CUN,” indicating that the end of the body 310 with the first bone indicator 360 is to be positioned over the first cuneiform 210. Similarly, the body 310 may have a second bone indicator 362 with the text “MET,” indicating that the end of the body 310 with the second bone indicator 362 is to be positioned over the first metatarsal 230. In addition, the body 310 may have a side indicator 370 with the text “LEFT,” indicating that the cutting guide 300 is to be used in connection with the patient’s left foot. The side indicator 370 may be particularly helpful when bunion corrections are to be provided on both of the patient’s feet. In such a case, the surgeon may manufacture or receive two separate cutting guides: one for the left foot (the foot 200 of Figure 2) and another for the right foot (not shown).	94	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Figure 4 is a perspective view of the foot 200 of Figure 2, with the cutting guide 300 of Figures 3A, 3B, 3C and 3D properly positioned on the first cuneiform 210 and the first metatarsal 230, but as yet not attached to the first cuneiform 210 and the first metatarsal 230. The surgeon has made the incision(s) to expose the dorsal surfaces of the first cuneiform 210 and the first metatarsal 230, and has inserted the cutting guide 300 such that the cuneiform apposition portion 342 (identified by the first bone indicator 360 on the outward-facing side 332 of the body 310) is resting on the corresponding dorsal surface of the first cuneiform 210, and the metatarsal apposition portion 344 (identified by the second bone indicator 362 on the outward-facing side 332 of the body 310) is resting on the corresponding dorsal surface of the first metatarsal 230. Since the cuneiform apposition portion 342 and the metatarsal apposition portion 344 are contoured to match the bone surfaces on which they rest, the body 310 may readily slide into its proper position on the first cuneiform 210 and the first metatarsal 230.	95	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Notably, the joint probe 320 (not visible) may reside between the first cuneiform 210 and the first metatarsal 230 (i.e., distal to the first cuneiform 210 and proximal to the first metatarsal 230). The surgeon may need to cut the metatarsocuneiform joint between the first cuneiform 210 and the first metatarsal 230 to form a space between the first cuneiform 210 and the first metatarsal 230 to receive the joint probe 320. Positioning the joint probe 320 in this space may further help to ensure that the cutting guide 300 is properly aligned relative to the first cuneiform 210 and the first metatarsal 230.	96	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Figure 5 is a perspective view of the foot 200 of Figure 2, with the cutting guide 300 of Figures 3A, 3B, 3C, and 3D properly positioned on the first cuneiform 210 and the first metatarsal 230 and attached to the first cuneiform 210 and the first metatarsal 230 in preparation for resection of the first cuneiform 210 and the first metatarsal 230. Specifically, pins 500 may be inserted through the holes 340 in the body 310 and anchored in the first cuneiform 210 and the first metatarsal 230. Each of the pins 500 may have a sharp and/or threaded distal end that can penetrate and/or readily be retained in the bone of the first cuneiform 210 or the first metatarsal 230. Additionally or alternatively, a drill or other hole-forming instrument may be used to pre-form holes in the first cuneiform 210 and/or the first metatarsal 230 to receive the distal ends of the pins 500.	97	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Figure 15 illustrates an exemplary embodiment of a parallel distractor that can be used with certain embodiments.	29	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The various apparatus, devices, systems, and/or methods of the present disclosure have been developed in response to the present state of the art, and in particular, in response to the problems and needs in the art that have not yet been fully solved by currently available technology. One general aspect of the present disclosure can include a patient specific instrument for correcting a condition present in a patient. The patient specific instrument may include a body that may include: a proximal side, a distal side, a medial side, and a lateral side; an inferior side that may include 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; a superior side that may include a first guide feature and a second guide feature that together, with the bone engagement surface overlying the first surface and the second surface, are positioned to guide resection of the first bone and the second bone during a surgical osteotomy for correcting the condition. The instrument includes where the body is configured to seat transverse to the joint with the bone engagement surface engaging the first surface of the first bone and the second surface of the second bone.	3	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Implementations may include one or more of the following features. The patient specific instrument where when the bone engagement surface seats over the joint: the first guide feature is configured to define a first cut surface formed by resection of the first bone; the second guide feature is configured to define a second cut surface formed by resection of the second bone; where 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 where the first cut surface is perpendicular to a longitudinal axis of the first bone. One of the first guide feature and the second guide feature may include a position and an orientation, at least one of which is based on patient imaging data. In one implementation, 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.	4	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The body may include: a proximal arm extending from the body; and a distal arm extending from the body and away from the proximal arm; and where: the distal arm may include a first bone attachment feature positioned perpendicular to the first guide feature and parallel with a first alignment feature configured to be coupled to the first bone; the proximal arm may include a second bone attachment feature and a second alignment feature each positioned perpendicular to the second guide feature; and where the first alignment feature and first bone attachment feature are not aligned and the first alignment feature and the second alignment feature are configured to align when the first bone is rotated. The second bone attachment feature and the second alignment feature may include a single feature.	5	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The body may extend between a lateral end of the joint and a medial end of the joint and the proximal arm and the distal arm are aligned and extend proximal to the lateral end of the joint. At least one of the body, the proximal arm, the distal arm, and the bone engagement surface of the inferior side of the body is configured to engage a dorsal surface of one or more of the first bone and the second bone. The first alignment feature and second alignment feature are configured to couple with an active compression instrument that compresses the first bone and the second bone for deployment of fasteners that connect the first bone and the second bone. The lateral side of the body may include a lateral superior surface and a lateral inferior surface that meet at a lateral edge, the lateral inferior surface angled to connect the inferior side of the body and the lateral edge such that the lateral inferior surface does not impinge upon soft tissue near the joint.	6	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The medial side of the body may include a medial superior surface and a medial inferior surface that meet at a medial edge, the medial inferior surface angled to connect the inferior side of the body and the medial edge such that the medial inferior surface does not impinge upon soft tissue near the joint. The bone engagement surface of the inferior side of the body is configured to engage a dorsal surface of one or more of the first bone and the second bone.	7	Added by DJM 2 2022	2/25/22, 12:00 AM

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