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, the body 310 is configured to reside on the dorsal surfaces of the first cuneiform and the first metatarsal to provide proper alignment of the body 310 with the metatarsocuneiform joint (e.g., the joint between the first metatarsal and the medial cuneiform bone, aka a TMT joint). In another embodiment, the body 310 is configured to reside or sit between the medial surfaces and the dorsal surfaces, or on the medial surfaces of the first cuneiform and the first metatarsal to provide proper alignment of the body 310 with the metatarsocuneiform joint (e.g., the joint between the first metatarsal and the medial cuneiform bone) for an osteotomy.	91	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, the bone engagement surface 324 may include a cuneiform apposition portion 326 and a metatarsal apposition portion 328. As shown, the cuneiform apposition portion 326 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 328 may similarly be contoured to match the contour of the surface of the first metatarsal on which it is to rest. (See Figure 3C) Thus, the body 310 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.	92	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	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 324 can engage the surfaces of the bones of a joint in a single configuration. Such a close matching fit facilitates the surgical osteotomy.	93	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 3D illustrates the cutting guide 300 from a view facing the medial side 316. Figure 3E illustrates the cutting guide 300 from a view facing the lateral side 318. In certain embodiments, the cutting guide 300 may include one or more features that facilitate use of the cutting guide 300 while avoiding certain soft tissue in the vicinity of a joint. For example, the medial side 316 may include a medial superior surface 332 and a medial inferior surface 334 that meet at a medial edge 336. Advantageously, the medial inferior surface 334 may extend from inferior side 322 to the medial edge 336 at an angle such that the medial inferior surface 334 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 about 170 degrees. In another example, the lateral side 318 may include a lateral superior surface 342 and a lateral inferior surface 344 that meet at a lateral edge 346. Of course, the medial superior surface 332 may extend from the superior side 320 to the medial edge 336 at an angle. The angle of the medial superior surface 332 may enable use of the cutting guide 300 in tighter openings and thus minimize the size of incisions used for a procedure.	94	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Advantageously, the lateral inferior surface 344 may extend from inferior side 322 to the lateral edge 346 at an angle such that the lateral inferior surface 344 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 about 170 degrees. Of course, the lateral superior surface 342 may extend from the superior side 320 to the lateral edge 346 at an angle. The angle of the lateral superior surface 342 may enable use of the cutting guide 300 in tighter openings and thus minimize the size of incisions used for a procedure.	95	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The body 310 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.	96	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In the embodiment of Figures 3A through 3H, 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 360 and a second slot 370. The first slot 360 may include a lateral end 362 and a medial end 364. The second slot 370 may include a lateral end 372 and a medial end 374.	97	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, the first slot 360 and the second slot 370 extend from the superior side 320 to the inferior side 322. In certain embodiments, the first slot 360 may extend from near the lateral side 318 to near the medial side 316. In other embodiments, one of, or both of, the first slot 360 and the second slot 370 may extend from one of the medial side 316 or the lateral side 318 of the body 310. In certain embodiments, the first slot 360 and second slot 370 intersect. In other embodiments, the first slot 360 and second slot 370 do not intersect.	98	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Thus, upon desired positioning of the cutting guide 300, the second slot 370 may be positioned over at least a portion of the first cuneiform to facilitate resection of the first cuneiform, while the first slot 360 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 370 is positioned near the distal end of the first cuneiform and the first slot 360 is positioned near the proximal end of the first metatarsal. The first slot 360 and second slot 370 together, with the bone engagement surface 324 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.	99	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 cutting guide 300.	100	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.	101	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 310 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 324, a position for a first slot 360, an orientation for a first slot 360, a position for a second slot 370, an orientation for a second slot 370, as well as other features and attributes of one or more patient specific instruments that can be used in a procedure.	102	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	"Cut surface" refers to a surface of an object that is created or formed by the removal of one or more parts of the object that includes the original surface. Cut surfaces can be created using a variety of methods, tools, or apparatuses and may be formed using a variety of removal actions, including, but not limited to, fenestrating, drilling, abrading, cutting, sawing, chiseling, digging, scrapping, and the like. Tools and/or methods used for forming a cut surface can include manual, mechanical, motorized, hydraulic, automated, robotic, and the like. In certain embodiments, the cut surface(s) are planar.	103	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	"Orientation" refers to a direction, angle, position, condition, state, or configuration of a first object, component, part, apparatus, system, or assembly relative to another object, component, part, apparatus, system, assembly, reference point, reference axis, or reference plane.	104	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 4 illustrates one embodiment of the cutting guide 300 secured to a first metatarsal 208 and a medial cuneiform 202. In the illustrated embodiment, the first resection feature may take the form of the first slot 360 and the second resection feature may take the form of the second slot 370. Referring now to Figures 4 and 3D, the position and/or angles (e.g., orientation) of one or both of the resection features based on patient imaging data is illustrated. In the illustrated embodiment, the first slot 360 is positioned between the distal side 314 and the second slot 370. The first slot 360 is oriented based on a desired angle for mitigating the condition of the patient. In one example, the first slot 360 is angled perpendicular to a longitudinal axis of the first metatarsal 208. This orientation of the first slot 360 enables the first cut surface to extend from the body 310 toward the bone to form a cut surface that is also perpendicular to the longitudinal axis 376 of one of the bones of a joint. "Longitudinal axis" refers to an axis of a structure, device, object, apparatus, or part thereof that extends from one end of a longest dimension to an opposite end. Typically, a longitudinal axis passes through a center of the structure, device, object, apparatus, or part thereof along the longitudinal axis. The center point used for the longitudinal axis may be a geometric center point and/or a mass center point. In the illustrated embodiment, the longitudinal axis 376 is the longitudinal axis of the first metatarsal 208.	105	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In the illustrated embodiment, the second slot 370 is positioned between the proximal side 312 and the first slot 360. In addition in the illustrated embodiment, the second slot 370 is oriented based on a desired angle for mitigating the condition of the patient. In the illustrated embodiment, the orientation of the second slot 370 can be described in reference to a first angle A and a second angle B. Figure 3D illustrates first angle A. In one embodiment, a second cut surface formed by resection using second slot 370 extends inferiorly away from a first cut surface formed by resection using first slot 360. Described another way, angle A is an angle between a first plane 378 that includes the first slot 360 and a first cut surface formed by resection using first slot 360 and a second plane that includes the second slot 370 and a second cut surface formed by resection using second slot 370, the second plane extending from the first plane toward the proximal side 312 of the body 310. In certain embodiments, angle A can range between about 4 degrees to about 18 degrees. In certain embodiments, angle A may start at 0 degrees and then increase to a positive number of degrees as illustrated or decrease to a negative number of degrees depending on how a surgeon may prescribe adjustments for a correction.	106	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 3H illustrates second angle B. In one embodiment, a second cut surface formed by resection using second slot 370 extends posteriorly away from a first cut surface formed by resection using first slot 360. Described another way, in the illustrated embodiment, angle B is an angle between the first plane 378 that includes the first slot 360 and a first cut surface formed by resection using first slot 360 and a third plane 381 that includes the second slot 370 and a second cut surface formed by resection using second slot 370, the third plane 381 extending from the first plane toward the proximal side 312 of the body 310. In certain embodiments, angle B can range between about 0 degrees to about 35 degrees. In certain embodiments, angle B may start at 0 degrees and then increase to a positive number of degrees as illustrated or decrease to a negative number of degrees depending on how a surgeon may prescribe adjustments for a correction.	107	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 360 and second slot 370 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. For example in the illustrated embodiment, the medial end 364 of the first slot 360 is closer to the medial end 374 of the second slot 370 than the lateral end 362 is in relation to the lateral end 372. In another embodiment, the lateral end 362 of the first slot 360 may be closer to the lateral end 372 of the second slot 370 than the medial end 364 is in relation to the medial end 374. Of course in another embodiment, the first slot 360 and second slot 370 may be configured such that a first distance between lateral end 362 and lateral end 372 and a second distance between medial end 364 and medial end 374 are substantially the same.	108	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Referring to Figure 3D, in one embodiment, anatomical data about the patient can be used to define other structures of the cutting guide 300 or other patient specific instruments. For example, anatomical data about the patient that can be captured in the patient imaging data (e.g., due to the fidelity of the technology providing the patient imaging data) can be used to define how deep a first resection feature and/or second resection feature is. Controlling the depth of the first resection feature and/or second resection feature can be used to manage how deep a surgeon’s cutting instruments can reach within the first resection feature and/or second resection feature. Managing a depth for one or more resection features may be referred to as defining a patient specific height for the cutting guide 300.	109	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	For example, in one embodiment, patient imaging data can be used to define a distance between at a first top edge 366 of the first resection feature (e.g., first slot 360) and the first surface (e.g., a surface of a first bone such as a first metatarsal 208). Alternatively, or in addition, patient imaging data can be used to define a distance between at a second top edge 368 of the second resection feature (e.g., second slot 370) and the second surface (e.g., a surface of a second bone such as a medial cuneiform 202). Managing the distance between a first top edge 366 and/or second top edge 368 and a bone surface is one way to provide a stop within the cutting guide 300. The stop can serve to limit how deep a surgeon will resect hard tissue/soft tissue when using the cutting guide 300 for a procedure. If a surgeon resects until the resection instruments engages the stop, the surgeon can be assured that the resection extends to a desired depth (not too far and not too short).	110	Added by DJM Jan 2024	1/6/24, 10:03 PM

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