Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Application	Content	Paragraph Number	Notes	Modified
		Content		Paragraph Number	Notes	Any Field
View Edit Delete	PER-12	In one embodiment, a surgeon may desire to perform a wedge osteotomy. In this embodiment, the resection guide 2020a is designed such that the first trajectory 2042 converges with the second trajectory 2044 at a vertex 2102 having a wedge angle 2104, such that posterior resection feature 2022a and the anterior resection feature 2022b form a wedge osteotomy comprising a wedge bone fragment 2050 after formation of the first osteotomy 2046 and the second osteotomy 2048, the wedge angle 2104 determined based, at least in part, on the bone model 1204. Advantageously, the various aspects of the design of the resection guide 2020a and/or an accompanying surgical technique and/or complementary components 1930 can be done prior to fabrication of one or more components of the osteotomy system 2000. Thus, a surgeon can define or adjust the position of the vertex 2102, the number of degrees for the wedge angle 2104, a height 2106 of the body 2028, and the like. Of course, certain of these aspects may be predefined for a surgeon and/or recommendations made to a surgeon. Alternatively, or in addition, certain of these aspects may be patient-specific while others may be standard based on experience and/or established practice for a particular procedure.	333	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, a surgeon and/or a technician, working with the surgeon, may determine the size, shape, and/or configuration of a wedge bone fragment 2050 to be removed from the bone. Furthermore, a surgeon and/or a technician can determine whether to perform an osteotomy that forms a wedge bone fragment 2050 or an osteotomy that enables an opening wedge osteotomy or an osteotomy that does not include a wedge (closing or opening). The type of osteotomy to be performed can determine whether or not the first trajectory 2042 and/or second trajectory 2044 converge and/or the size of the posterior angle 2052 and/or anterior angle 2056.	334	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, a surgeon can also determine, preoperatively, whether the vertex 2102 will be inside the bone or outside the bone. For example, the surgeon may decide to have the vertex 2102 outside the bone a distance away from a medial surface 2108 of the bone (e.g., calcaneus 224). The position of the vertex 2102 may depend on the surgical procedure, surgeon preference, a surgeon’s planned correction, or the like. In such an embodiment, the first trajectory 2042 may converge with the second trajectory 2044 at a vertex 2102 outside the bone and spaced a distance from the medial cortex 2110 of the bone.	335	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In another instance, a surgeon may determine to have the vertex 2102 between the medial cortex 2110 of the bone and the resection guide 2020a when the resection guide 2020a is in use for a surgical procedure. Alternatively, or in addition, a surgeon may determine to have the vertex 2102 between a medial cortex 2110 of the bone and the resection guide 2020a when the resection guide 2020a is designed for a patient’s foot. In certain osteotomies, a surgeon may desire that the vertex 2102 is positioned within the bone and offset from the medial cortex 2110 by a predetermined offset 2112. Advantageously, using embodiments of the present disclosure a surgeon can determine and/or adjust the size of the predetermined offset 2112.	336	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	A surgeon may desired to position the vertex 2102 between the medial cortex 2110 of the bone and the resection guide 2020a when the resection guide 2020a is in use for a surgical procedure such that the first osteotomy 2046 and the second osteotomy 2048 leave bone between the vertex 2102 and the medial cortex 2110 intact. This intact bone may serve to keep a posterior bone fragment 2114 connected to an anterior bone fragment 2116. Depending on the surgical procedure planned, a surgeon may desire to keep this bone intact to serve as a “living hinge” which can be used to close the wedge osteotomy. Of course, different surgeons may have different sizes they want for predetermined offset 2112. Alternatively, or in addition, the size of the predetermined offset 2112 may be based at least in part on how the patient presents for the procedure or preparation and planning for the procedure.	337	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Advantageously, the present disclosure enables the thickness/size of the predetermined offset 2112 to be predetermined, to be patient-specific, as well as the determination of whether or not to have a predetermined offset 2112. As described, a surgeon may preposition the vertex 2102 to be within the bone or outside the bone.	338	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, the position of the vertex 2102 may be customized to a particular patient. The vertex 2102 position may be patient-specific. Alternatively, or in addition, the position of the vertex 2102 may be set at a default predetermined offset 2112, such as one millimeter. In another embodiment, the position of the vertex 2102 may be predetermined, for example due to the type of osteotomy being performed.	339	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, the position of the vertex 2102 may be fixed due to the type of osteotomy to be performed. Those of skill in the art will appreciate that with a fixed position of the vertex 2102 and based on a thickness of the bone at the location for the osteotomy, the size of the wedge angle 2104 can directly impact the width of the body 2028. Those of skill in the art will appreciate that the size of the wedge angle 2104 can vary depending on the needs of the patient, surgeon preferences, anatomical data, or the like. In one embodiment, the wedge angle 2104 may range from between about 5.0 degrees to about 45.0 degrees. In one embodiment, the wedge angle 2104 is about 13.4 degrees. In another embodiment, the wedge angle 2104 is about 18.3 degrees. Advantageously, a user or surgeon can define and/or adjust the wedge angle 2104 in a tool that views and/or edits parameters for the bone model and/or for a model of the resection guide 2020. In one embodiment, the wedge angle 2104 is determined based on the bone model.	340	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 21J also illustrates a one fastener 2010 secured within a first bone attachment feature 2024a. The first bone attachment feature 2024a secures the resection guide 2020 to a portion of the bone during an osteotomy. The bone attachment feature 2024 secures the resection guide 2020a to a portion of the bone that forms the wedge bone fragment 2050 after formation of a wedge osteotomy. As described herein, the osteotomy system 2000 may include a second bone attachment feature 2024b that can be used to secure the resection guide 2020a to the bone. In one embodiment, the first bone attachment feature 2024a and second bone attachment feature 2024b include fasteners 2010 that enter the bone in parallel to each other, to facilitate removal of the resection guide 2020a while leaving the fasteners 2010 in the bone. In the illustrated embodiment, the fasteners 2010 in the first bone attachment feature 2024a and second bone attachment feature 2024b both enter the portion of the bone that becomes the wedge bone fragment 2050. With the fasteners 2010 in the wedge bone fragment 2050, the wedge bone fragment 2050 can be readily manipulated and/or removed during a surgical procedure.	341	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Advantageously, embodiments of the present disclosure enable a user (e.g., a technician, and/or a surgeon) to visualize and work with the bone model as well as a model of the resection guide 2020 before the resection guide 2020 is fabricated. Accordingly, a user can identify and measure the effects of one or more osteotomies formed using the resection guide 2020 along the first trajectory 2042 and/or the second trajectory 2044. In addition, a user can change the first trajectory 2042, the second trajectory 2044, the positions of the posterior resection feature 2022a and/or the anterior resection feature 2022b relative to each other (in one, two, or three planes), and a variety of other aspects of the resection guide 2020 and/or the osteotomy system 2000 before instruments are fabricated and used on patient. Thus, a user can design and/or revise the resection guide 2020 and its characteristics and features to accomplish a customized surgical procedure and/or outcome for the patient.	342	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Referring back to Figures 11, 12, and/or 17, the embodiments of the present disclosure may use one or more bone models (e.g., bone model 1204) in determining, partially determining, and/or as a factor in identifying, positioning, selecting, orienting, and/or defining components of the osteotomy systems. Those of skill in the art will appreciate that the accuracy of and/or fidelity of the bone model can vary depending on the technology and/or equipment used to capture and/or process the medical imaging. Consequently, in one embodiment, the accuracy and fidelity and/or quality of the medical imaging and/or processing to generate a three dimensional bone model may result in a bone model having each of the same features as the corresponding bone of a patient such that bone model 1204 may match or substantially may match the anatomy of a patient’s foot. In another embodiment, the accuracy and fidelity and/or quality of the medical imaging and/or processing to generate a three dimensional bone model may be such that the accuracy, fidelity, and/or quality may be less than the highest. In such an instance, the bone model 1204 may resemble or significantly resemble the anatomy of a patient’s foot. This may mean that certain features and/or aspects are exactly the same while others are similar but not actually the same as corresponding features on bone(s) of the patient.	343	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Furthermore, those of skill in the art will appreciate that the bone model 1204 may model a portion of a single bone of a patient. Alternatively, or in addition, the bone model 1204 may model all or substantially all of a single bone of a patient. Alternatively, or in addition, the bone model 1204 may model a plurality of bones of a patient.	344	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Referring now to Figure 21J, the resection guide 2020a can be used for a surgical procedure on a calcaneus 224, or another bone, of a patient. The resection guide 2020a may include at least one bone attachment feature. In one embodiment, a user may secure the resection guide 2020a to the calcaneus 224 by deploying at least one fastener 2010 through the at least one bone attachment feature and into the calcaneus 224.	345	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In the illustrated embodiment, the resection guide 2020a includes a posterior resection feature 2022a and an anterior resection feature 2022b. The posterior resection feature 2022a is configured to guide a cutting tool to form a first osteotomy 2046. The anterior resection feature 2022b is configured to guide a cutting tool (which may be the same cutting tool) to form a second osteotomy 2048.	346	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The posterior resection feature 2022a extends through the resection guide 2020a from the lateral side 2030 to the medial side 2032 along the first trajectory 2042. The first trajectory 2042 is at least partially determined based on a calcaneus model of at least a portion of a calcaneus of a patient’s foot. The calcaneus model is based on medical imaging of the patient’s foot and is configured to resemble, significantly resemble, and/or match the anatomy of the patient’s foot. Alternatively, or in addition, the anterior resection feature 2022b extends through the resection guide 2020 from the lateral side 2030 to the medial side 2032 along the second trajectory 2044. The second trajectory 2044 is at least partially determined based on the calcaneus model of at least a portion of the calcaneus 224 of the patient’s foot.	347	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In the illustrated embodiment, the second osteotomy 2048 connects with the first osteotomy 2046 to form a wedge bone fragment 2050. Advantageously, the wedge bone fragment 2050 is connected to the at least one fastener 2010. This connection enables a surgeon to readily remove and/or manipulate the wedge bone fragment 2050, as needed.	348	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, a posterior resection feature 2022a may extend from a lateral side 2030 to a medial side 2032 at a posterior angle 2052, the posterior angle 2052 may be an angle measured in degrees from an axis 2054 parallel to a lateral side 2030 of the body 2028 to the first trajectory 2042. An anterior resection feature 2022b may extend from a lateral side 2030 to a medial side 2032 at an anterior angle 2056, the anterior angle 2056 may be an angle measured in degrees from the axis 2054 to the second trajectory 2044.	349	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The posterior angle 2052 may be determined, at least partially, based on a calcaneus model derived from medical imaging of a calcaneus of a patient’s foot. In one embodiment, the calcaneus model is configured to significantly resemble the anatomy of the patient's foot. The anterior angle 2056 may be determined based on the calcaneus model. Furthermore, the anterior angle 2056 may be determined such that an osteotomy formed by way of the posterior resection feature 2022a and the anterior resection feature 2022b forms a wedge osteotomy. The wedge osteotomy includes a wedge bone fragment 2050. In certain embodiments, the wedge bone fragment 2050 may be determined, at least partially, based on the calcaneus model.	350	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Referring still to Figure 21J, in one embodiment, the resection guide 2020a includes at least one bone attachment feature that may be configured to receive at least one fastener 2010. The fastener 2010 may engage a portion of the calcaneus before formation of the wedge osteotomy. Advantageously, the fastener 2010 may extend into the calcaneus such that the fastener 2010 does not interfere with the wedge osteotomy, but the fastener 2010 also engages the wedge bone fragment 2050 after formation of the wedge osteotomy.	351	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Those of skill in the art will appreciate that the posterior resection feature 2022a and/or anterior resection feature 2022b can have a variety of different designs and may be similar to each other or different from each other. In the illustrated embodiment, the resection features 2022 have a similar mirrored configuration, one for the posterior resection feature 2022a and one for the anterior resection feature 2022b. Generally, resection features 2022 include openings that may also be referred to as slots, channels, or the like. Likewise, the posterior resection feature 2022a and/or anterior resection feature 2022b may have the same or similar or different opening configurations.	352	Added by DJM Jan 2024	1/6/24, 10:03 PM

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