Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Application	Content	Paragraph Number	Notes	Modified
		Content		Paragraph Number	Notes	Any Field
View Edit Delete	PER-12	Advantageously in certain embodiments, the present disclosure can be used to prepare a preoperative plan, one or more instruments, implants, or guides, including implants and/or guides that are patient-specific, and/or to perform one or more osteotomies on any body part of a patient.	275	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 18 illustrates a couple of examples of osteotomies that can be performed. In particular, the present disclosure can be used to perform wedge osteotomies.	276	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 19 illustrates an exemplary osteotomy system 1900, according to one embodiment. The osteotomy system 1900 can include one or more fasteners 1910, one or more resection guides 1920, and one or more complementary components 1930. While an osteotomy system 1900 can be used for any osteotomy procedure, one or more features, components, and/or aspects of the osteotomy system 1900 may be particularly suited for a wedge osteotomy, an Evans osteotomy, a Kouts osteotomy, or the like.	277	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, the one or more fasteners 1910 can include both one or more permanent fasteners and one or more temporary fasteners. Typically, the fasteners 1910 may be used during a variety of different steps of procedure. Temporary fasteners are often used because they can securely hold bone or parts of bones well steps of the procedure are conducted. A common temporary fastener that can be used with osteotomy systems 1900 is a K-wire, also referred to as a pin.	278	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The one or more resection guides 1920 assist a surgeon in performing different resection steps for an osteotomy procedure. In certain embodiments, a resection guide 1920 includes one or more resection features 1922 and one or more bone attachment features 1924. The resection features 1922 can take a variety of forms and/or embodiments. Similarly, the bone attachment features 1924 can take a variety of forms and/or embodiments. The resection features 1922 provide a guide for a surgeon using a cutting tool to resect a bone, one or more bones, or other tissues of a patient. The bone attachment features 1924 serve to secure the resection guide 1920 to one or more bones and/or one or more other structures. Often, a bone attachment features 1924 can include a hole in the resection guide 1920 together with a temporary fastener such as a K-wire or pin.	279	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, a resection guide 1920 may include one or more bone engagement surfaces 1926 and/or one or more landmark registration features 1928. "Landmark registration features" refers to a structure configured to engage with a feature, aspect, attribute, or characteristic of a first object to orient and/or position a second object that includes the landmark registration feature with respect to the first object. A variety of structures can serve as a landmark registration feature. For example, a landmark registration feature may include a protrusion, a projection, a tuberosity, a cavity, a void, a divot, a tab, an extension, a hook, a curve, or the like. Similarly, a variety of structures can serve as a landmark that engages with a landmark registration feature. For example, in the context of a bone, a landmark may include head, neck, condyle, epicondyle, tuberosity, tubercle, crest, spine, process, trochanter, linea, fossa, foramen, notch, groove or sulcus, a protrusion, a projection, a tuberosity, a cavity, a void, a divot, a tab, an extension, a hook, a curve, a surface of a bone such as a medial surface, a lateral surface, an anterior surface, a posterior surface, a plantar surface, or the like.	280	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The body 610 may further include resection 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 resection features may be used to guide a planar cutting blade, an arcuate cutting blade, a drill or mill, a burr, and/or the like.	141	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In the embodiment of Figures 6A through 6C, the resection 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 resection features may take the form of a first slot 660 and a second slot 670. The first slot 660 may include a lateral end 662 and a medial end 664. The second slot 670 may include a lateral end 672 and a medial end 674.	142	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, the first slot 660 and the second slot 670 extend from the superior side 620 to the inferior side 622. In certain embodiments, the first slot 660 may extend from near the lateral side 618 to near the medial side 616. In other embodiments, one of, or both of, the first slot 660 and the second slot 670 may extend from one of the medial side 616 or the lateral side 618 of the body 610. In certain embodiments, the first slot 660 and second slot 670 intersect. In other embodiments, the first slot 660 and second slot 670 do not intersect.	143	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Thus, upon desired positioning of the cutting guide 600, the second slot 670 may be positioned over at least a portion of the first cuneiform to facilitate resection of the first cuneiform, while the first slot 660 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 670 is positioned near the distal end of the first cuneiform and the first slot 660 is positioned near the proximal end of the first metatarsal. The first slot 660 and second slot 670 together, with the bone engagement surface 624 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.	144	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In alternative embodiments, a resection feature may be designed to guide a different type of cutter, such as a drill, mill, or side-cutting burr. In such embodiments, the resection 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 resection features may be replaced by a single resection feature sized to permit a surgeon to resect both a first cuneiform and a first metatarsal using a single cutting guide 600.	145	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, a first resection feature is configured to define a first cut surface that can be formed by resecting a first bone. A second resection feature is configured to define a second cut surface that can be formed by resecting a second bone. In such an embodiment, one or the other or both of the first cut surface and the second cut surface can be oriented according to one or more angles relative to landmarks on the bones or other anatomical structures.	146	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Alternatively, or in addition, in certain embodiments, one or both of, the first resection feature and second resection feature may be positioned on, or in, the body 610 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 resection feature and second resection 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 624, a position for a first slot 660, an orientation for a first slot 660, a position for a second slot 670, an orientation for a second slot 670, as well as other features and attributes of one or more patient specific instruments that can be used in a procedure.	147	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 6 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 resection feature may take the form of the first slot 660 and the second resection feature may take the form of the second slot 670. As with the embodiment of Figures 3A-19H and 20, the position and/or angles (e.g., orientation) of one or both of the resection features based on patient imaging data is illustrated. The first slot 660 is oriented based on a desired angle for mitigating the condition of the patient. In one example, the first slot 660 is angled perpendicular to a longitudinal axis 676 of the first metatarsal 208. This orientation of the first slot 660 enables the first cut surface to extend from the body 610 toward the bone to form a cut surface that is also perpendicular to the longitudinal axis 676 of one of the bones of a joint.	148	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In the illustrated embodiment, the second slot 670 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 670 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 Figure 3D and 3H.	149	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 position and orientation of the first slot 660 and second slot 670 and the corresponding cut surface a surgeon can form using these resection features can vary depending on the anatomical structures of the patient, the osteotomy procedure being performed, preferences of the surgeon, the nature of the condition, and the like.	150	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Referring to Figures 6C and 23, in one embodiment, the body 610, or one or more arms, may include one or more bone attachment features that facilitate attachment of the body 610 to the medial cuneiform 202 and/or first metatarsal 208. Such bone attachment features may include any of a wide variety of fasteners including, but not limited to, holes, spikes, fastening devices, and/or the like. Effective connection of the cutting guide 600 to one or more bones across a joint can ensure that cut surfaces are formed in desired locations and orientation and mitigate removal of hard tissue and/or soft tissue outside in undesired locations.	151	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Accordingly, the cutting guide 600 includes one or more bone attachment features. As embodied in Figures 6A through 6C, the bone attachment features may take the form of one or more holes 650 that extend from the inferior side 622 to the superior side 620 and/or one or more fixation devices. The holes 650 may be shaped to accommodate pins, K-wires, and/or other elongated bone fixation elements that can be anchored in the medial cuneiform 202 and/or the first metatarsal 208 to keep the cutting guide 600 in place.	152	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 6 illustrates one example of a cutting guide 600 coupled to the bones using a proximal bone attachment feature 652 and a distal bone attachment feature 654. In the illustrated embodiment, the proximal bone attachment feature 652 includes at least hole 650 and a fastener and the distal bone attachment feature 654 includes at least hole 650 and a fastener. In Figure 6 the fasteners are K-wires. Advantageously, the proximal bone attachment feature 652 and the distal bone attachment feature 654 each include at least holes 650, each with a K-wire passing through the hole 650 and into bone facing the inferior side 622. Using holes 650 and two fasteners ensures a stable coupling between the cutting guide 600 and the bone(s). Advantageously, in certain embodiments, the holes 650 of the proximal bone attachment feature 652 and distal bone attachment feature 654 are align such that inserted K-wires are parallel to each other. Among other benefits, parallel K-wires of each of the proximal bone attachment feature 652 and distal bone attachment feature 654 prevent the cutting guide 600 from pivoting around one of the K-wires of a proximal bone attachment feature 652 or a distal bone attachment feature 654.	153	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In the illustrated embodiment, the proximal arm 630 includes the proximal bone attachment feature 652 and the distal arm 640 includes the distal bone attachment feature 654. In one embodiment, the holes 650 of the proximal bone attachment feature 652 are aligned with each other and aligned perpendicular to a resection feature such as the second slot 670 (see reference line 392). The holes 650 of the distal bone attachment feature 654 may also be aligned with each other and aligned perpendicular to another resection feature such as the first slot 660 (see reference line 394). This means that the aligned holes 650 (and K-wires secured within them) of the distal bone attachment feature 654 will also be perpendicular to the cut surface formed using the first slot 660. This also means that the aligned holes 650 (and K-wires secured within them) of the proximal bone attachment feature 652 will also be perpendicular to the cut surface formed using the second slot 670. Consequently, at least one of the proximal bone attachment feature 652 and the distal bone attachment feature 654 can be used to position and orient a cut surface of the first metatarsal 208 and a cut surface of the medial cuneiform 202. In certain embodiments, the proximal bone attachment feature 652 and distal bone attachment feature 654 may not be aligned with each other, the offset in the alignment may be the change in orientation of the bones of the joint desired to address the condition. It should be noted that the distal bone attachment feature 654 may be parallel to the longitudinal axis 676. In this manner, the distal bone attachment feature 654 can be used as a reference for positioning a distal alignment feature 690 on the first metatarsal 208.	154	Added by DJM Jan 2024	1/6/24, 10:03 PM

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