Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Application	Content	Paragraph Number	Notes	Modified
		Content		Paragraph Number	Notes	Any Field
View Edit Delete	PER-12	Z osteotomy	440	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 30 illustrates an exemplary osteotomy system 3000 for a Z osteotomy, according to one embodiment. The osteotomy system 3000 can include two or more fasteners 3010 (3010a, 3010b), a resection guide 3020, and one or more complementary components 1930. While specific embodiments of complementary components 1930 are not specifically shown here in relation to the osteotomy system 3000, those of skill in the art will appreciate that complementary components 1930 similar in feature, purpose, design, implementation, configuration, and purpose as those described in relation to the wedge osteotomy system 2000 can be used for the osteotomy system 3000. Thus, the osteotomy system 3000 can include one or more alignment guides 1940, rotation guides 1950, correction guides 1960, compression guides 1970, positioning guides 1980, fixation guides 1990, one or more pin guides 1994, and/or implants 1996.	441	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 31 illustrates a stage of performing a surgical osteotomy procedure (e.g., a Z osteotomy) using the osteotomy system of Figure 30, according to one embodiment. Typically, the preferred approach for a Z osteotomy is on the lateral side of the calcaneus 1806. Figure 31 illustrates the resection guide 3020 positioned on the calcaneus 1806, the resection guide 3020 may be secured to the calcaneus 1806 by way of fasteners 3010.	442	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figures 32A-32F illustrate views of a resection guide of an osteotomy system, according to one embodiment. The resection guide 3020 can include some or all of the same or substantially the same features, aspects, and/or components as the resection guide 2020. Accordingly, the resection guide 3020 can or may include one or more resection features 3022 (e.g., resection features 3022a,b), one or more bone attachment features 3024 (e.g., bone attachment features 3024a-d), one or more handles 3026 (e.g., handles 3026a,b), one or more bone engagement surfaces 3030, and one or more landmark registration features 3028 (e.g., landmark registration feature 3028a,b). Similarly, features of the resection guide 3020 (e.g., resection features 3022, bone attachment features 3024, handles 3026, landmark registration features 3028, and bone engagement surfaces 3030) may be the same, similar, or substantially similar to those of the resection guide 1920, resection guide 2020, and/or resection guide 2520 described above. Of course, the features of the resection guide 3020 may be configured to facilitate the particular osteotomy procedure (e.g., Z).	443	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In addition, the resection guide 3020 includes a lateral side 3031, a medial side 3032, a proximal side 3033, a distal side 3034, a superior side 3035, and an inferior side 3036. Generally, the sides of the resection guide 3020 refer to the direction the sides face when the resection guide 3020 is in use. In certain embodiments, one or more of the handles 3026 can serve as both a handle used by a user to position the resection guide 3020 and/or as a landmark registration feature 3028. The landmark registration feature 3028 can provide the same features, advantages, and/or benefits as the landmark registration feature 2042 described above.	444	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figures 32E-32F illustrate views of the resection guide of Figures 27A-27D, according to another embodiment. These figures illustrate the medial side 3032 and the bone engagement surface 3030.	445	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 32G illustrates a cross section view of the resection guide 3020 taken along a plane that extends from the inferior side 3036 to the superior side 3035. Figure 32G illustrates two sections 3040, 3042 of the resection features 3022. On the lateral side 3031 the two sections 3040, 3042 may be parallel (horizontal). However, using the present disclosure the two sections 3040, 3042 can extend toward the medial side 3032 at the same or different angles. Figure 32G illustrates one embodiment in which the dorsal section 3040 extends plantarly at an angle A and the plantar section 3042 extends dorsally at an angle B. Advantageously, using the apparatuses, methods, and systems of the present disclosure the angles for A and B can be determined preoperatively. Alternatively, or in addition, the angles can be predetermined to ensure that a resection through the dorsal section 3040 and/or plantar section 3042 will result in a wedge shape being resected. In addition, the wedge shape can be predefined to not extend to the medial cortex of the bone. In this manner, two parts of the bone can remain connected and that connection can be leveraged for subsequent steps in a surgical procedure.	446	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Referring to Figure 32F, those of skill in the art will appreciate that other sections 3044, 3046 (e.g., sections that run vertically when the resection guide 3020 is used) may also extend at one or more angles to guide resection of the bone along a desired path through the bone. The proximal section 3044 can be angled such that resection using the resection features 3022 resects in a single plane or in multiple planes. Similarly, The distal section 3046 can be angled such that resection using the resection features 3022 resects in a single plane or in multiple planes. Advantageously, the angles for the resection features 3022 can be patient-specific and/or can be predefined and included in multiple versions of the resection guide 3020 available in a kit for a surgeon to use.	447	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Akin osteotomy	448	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Following Lapidus surgery, surgeons and/or patients may feel that the distal portion of the big toe is not straight and normal looking. Therefore, surgeons may recommend an Akin osteotomy in which a medial to lateral closing wedge osteotomy is performed to straighten the toe (e.g., the proximal and distal phalanx). It is advantageous when performing an Akin osteotomy to not cut completely through to the far cortex of the bone, but instead to leave a portion of bone at the far cortex to allow the closing distal portion of bone to pivot around the resected wedge of bone. Should the remaining bone portion at the far cortex be too thick, then during closure, the bone bridge (e.g., remaining bone portion) could fracture resulting on the proximal phalanx becoming two separate pieces. Should the remaining bone portion at the far cortex be too thin, the two bone portions could break also resulting in two separate pieces. Having two separate pieces makes for greater challenges during fixation as the bone parts are now floating (free to move) relative to each other.	449	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The present disclosure relates to a resection guide 3320 for use in an Akin osteotomy in which a wedge angle for the closing wedge is defined by the amount of correction needed to bring the two into proper alignment and wherein the specific apex of the triangle for the two saw blade channels terminates at a position (e.g., vertex) relative to the far cortex of the proximal phalanx to optimize closure of the osteotomy while avoiding total fracture or resection (separation) of the two bone fragments. Advantageously, the angles for the closing wedge are patient-specific and are designed preoperatively and achieved using a resection guide 3320 built for a particular procedure and use on a particular patient.	450	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 33 illustrates an exemplary osteotomy system 3300 for an Akin osteotomy, according to one embodiment. The osteotomy system 3300 can include at least one fastener 3310 and a resection guide 3320. The fastener 3310 can be configured to engage a phalanx of a patient’s foot. In another embodiment, the osteotomy system 3300 can include a resection guide 3320 and one or more complementary components 1930. Those of skill in the art will appreciate that complementary components 1930 similar in feature, purpose, design, implementation, configuration, and purpose as those described in relation to the wedge osteotomy system 2000 can be used for the osteotomy system 3300. Thus, the osteotomy system 3300 can include one or more alignment guides 1940, rotation guides 1950, correction guides 1960, compression guides 1970, positioning guides 1980, fixation guides 1990, one or more pin guides 1994, and/or implants 1996.	451	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In the illustrated embodiment, the osteotomy system 3300 includes complementary components 1930 such as a fixation guide 3390. In certain embodiments, the osteotomy system 3300 includes two different kinds of fixation guides 3390. Fixation guide 3390a may serve to enable temporary fixation during the osteotomy procedure and the fixation guide 3390b may serve to enable permanent fixation. The fixation guide 3390a may facilitate fixation using a compression screw by guiding placement of a K-wire that is then used to deploy a cannulated compression screw. In one embodiment, the fixation guide 3390a may be referred to as a targeting jig. Of course, the fixation guide 3390a may be integrated with the resection guide 3320. The fixation guide 3390b may be an example of a fixation guide 3390 integrated with a resection guide 3320. The fixation guide 3390b may facilitate fixation using a bone staple, or other fastener, by providing pilot holes for staple legs that can be used to deploy a bone staple.	452	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figures 34A-34F illustrate views of a resection guide of an osteotomy system, according to one embodiment. The resection guide 3320 can include some, or all, of the same, or substantially the same, features, aspects, and/or components as the resection guide 2020. Accordingly, the resection guide 3320 can, or may, include one or more resection features 3322 (e.g., resection features 3322a-b), one or more bone attachment features 3324 (e.g., bone attachment features 3324a-b), one or more handles, one or more landmark registration features, one or more bone engagement surfaces 3330, or the like. Similarly, features of the resection guide 3320 (e.g., resection features 3322, bone attachment features 3324, and bone engagement surfaces 3330) may be the same, similar, or substantially similar to those of the resection guide 1920 or resection guide 2020 described herein. Of course, the features of the resection guide 3320 may be configured to facilitate the particular osteotomy procedure (e.g., Akin).	453	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In addition, the resection guide 3320 includes a body 3420 having a lateral side 3331, a medial side 3332, a posterior side 3333, an anterior side 3334, a dorsal side 3335, and a plantar side 3336. Generally, the sides of the resection guide 3320 refer to the direction the sides face when the resection guide 3320 is in use. In certain embodiments, the resection guide 3320 may include an indicator 3338 that identifies for a user which side (proximal/posterior or distal/anterior) is the anterior side 3334. In the illustrated embodiment, the indicator 3338 may be a large letter “D” on the medial side 3332 to indicate a dorsal end of the resection guide 3320.	454	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, the resection guide 3320 includes a posterior resection feature 3322a, an anterior resection feature 3322b, a first bone attachment feature 3324a, and a second bone attachment feature 3324b. The posterior resection feature 3322a is configured to guide a cutting tool to form a first osteotomy in a phalanx that follows a first trajectory. The first trajectory for first osteotomy can be determined, at least in part, based on a bone model or a portion of a bone model of the phalanx based, at least in part, on medical imaging of the patient’s foot. The bone model may be configured to significantly resemble and/or match the anatomy of the patient's foot. The first trajectory and/or first osteotomy may be created, identified, and/or used in a similar manner to the first trajectory 2042 and/or the first osteotomy 2046. The anterior resection feature 3322b is configured to guide a cutting tool to form a second osteotomy in the phalanx that follows a second trajectory. The second trajectory for second osteotomy can be determined, at least in part, based on the bone model. The second trajectory and/or second osteotomy may be created, identified, and/or used in a similar manner to the second trajectory 2044 and/or the second osteotomy 2048.	455	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, the resection guide 3320 can include a single bone attachment feature 3324. Alternatively, or in addition, the resection guide 3320 may include a first bone attachment feature 3324a and a second bone attachment feature 3324b. The one or more bone attachment features 3324 serve to secure the resection guide 3320 to a bone such as a phalanx of a patient. In certain embodiments, the one or more bone attachment features 3324 can be embodied as a hole in the body 3420 and a fastener (e.g., a K-wire).	456	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figures 35A-35C illustrate different stages of performing a surgical osteotomy procedure (e.g., an Akin osteotomy) using an osteotomy system, according to one embodiment. Figures 35A-35B illustrate a medial cuneiform bone 3402, first metatarsal bone 3404, first proximal phalanx 3406, first distal phalanx 3408, and other bones of a foot. Typically, the preferred approach for an Akin osteotomy is on the medial side of the proximal phalanx (e.g., first proximal phalanx 3406). Figure 35A illustrates the resection guide 3320 secured to the proximal phalanx by way of fasteners 3310.	457	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 35B illustrates a dorsal view of the resection guide 3320 secured to the first proximal phalanx 3406. The resection guide 3320 includes resection features 3322a,b (e.g. cut channels). The cut channels are designed to create an angled cut in the bone to address a patient deformity (e.g., provide an anatomical correction) The channels may converge to form an apex 3412 of a resection wedge. The apex 3412 may be proximal to a far cortex of the bone, but not be at the far cortex of the bone.	458	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, one or the other or both of the first bone attachment feature 3324a and/or the second bone attachment feature 3324b can be designed together with a bone model of the bone of the patient (e.g., a phalanx). The bone attachment features 3324 can be specifically configured to include a hole for a fastener that enters a bone of a patient to a depth, at an orientation, and/or having a diameter such that the hole formed by the fastener can be utilized for subsequent fixation of an osteotomy formed using the resection guide 3320. Advantageously, the fasteners 3310 can be positioned, oriented, and configured to be directed by way of the resection guide 3320 such that upon closure of an osteotomy, holes formed by removal of the fasteners 3310 create a guide hole 3422, or a pilot hole 3422. The guide hole and/or pilot hole can, upon closure, accept a fastener. The fastener may be a temporary fastener or a permanent fastener such as bone screw and/or a bone staple. In one embodiment, the fastener is suitable for spanning the osteotomy.	459	Added by DJM Jan 2024	1/6/24, 10:03 PM

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