Dave's PCF WIP: Paragraphs

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View Edit Delete	PER-12	Figure 38 illustrates an exemplary osteotomy system for an osteotomy, according to one embodiment. In one embodiment, the osteotomy system 3800 is for a Koutsogiannis' osteotomy (“Kouts”) surgical procedure. The osteotomy system 3800 may include fasteners 2010, a resection guide 3820, one or more positioning guides 3810, and/or a fixation guide 3890.	480	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The osteotomy system 3800 can include some, or all, of the same, or substantially the same, features, aspects, and/or components as the other systems included in the present disclosure. Accordingly, the resection guide 3820 can, or may, include one or more resection features 3822 (e.g., resection features 3822a-b), one or more bone attachment features 3824 (e.g., bone attachment features 3824a-b), one or more handles, one or more landmark registration features, one or more bone engagement surfaces 3830, or the like. Similarly, any of the features and/or aspects of the resection guide 3820 (e.g., resection features 3822, bone attachment features 3824, and bone engagement surfaces 3830) may be patient-specific as described herein and may be based at least in part on bone models of one or more bones or portions of bones of a patient. Of course, the features of the resection guide 3820 may be configured to facilitate the particular osteotomy procedure (e.g., Kouts).	481	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Similarly, the positioning guides 3810 (e.g., positioning guide 3810a and/or positioning guide 3810b) can, or may, include alignment features (e.g., anterior alignment feature 3804 and/or posterior alignment feature 3806), one or more offset features 3808, one or more handles 3812, one or more landmark registration features, one or more bone engagement surfaces 3814, or the like. Similarly, any of the features and/or aspects of the positioning guides 3810 (e.g., alignment features, offset features 3808, and/or bone engagement surfaces 3814) may be patient-specific as described herein and may be based, at least in part, on bone models of one or more bones or portions of bones of a patient.	482	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Alternatively, or in addition, the fixation guide 3890 can, or may, include trajectory guide, a bone attachment feature, one or more sleeves, one or more fasteners, also referred to as guide pins, or the like. Similarly, any of the features and/or aspects of the fixation guide 3890 (e.g., trajectory guide, a bone attachment feature, one or more sleeves, etc.) may be patient-specific as described herein and may be based, at least in part, on bone models of one or more bones or portions of bones of a patient.	483	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figures 39A-39G illustrates different stages of performing a surgical osteotomy procedure (e.g., a Kouts osteotomy) using an osteotomy system of Figure 38, according to one embodiment. Typically, a preferred approach for a Kouts osteotomy is on the lateral side of the calcaneus 1806. In the illustrated embodiment, the surgical procedure creates a single osteotomy through the calcaneus 1806. According to one embodiment, a surgeon may access a lateral surface of the calcaneus 1806. Next a surgeon may position a resection guide 3820 on the lateral surface in a position predetermined using a calcaneus model of the patient’s calcaneus 1806. In certain embodiments, the step of positioning can include seating or registration of the resection guide 3820 to a surface of the calcaneus 1806 (a bone). The resection guide 3820 may be configured, for example, as one of the resection guides described herein.	484	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Once positioned, a surgeon may deploy a first fastener 2010a into a first bone attachment feature 3824a and a second fastener 2010b into second bone attachment feature 3824b. In one embodiment, the bone attachment features 3824 are configured such that the first fastener and second fastener are parallel relative to each other. Next, a surgeon may direct a cutting tool into one or more resection features 3822. In the illustrated embodiment, the resection guide 3820 may include a first resection feature 3822a and a second resection feature 3822b.	485	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, the osteotomy system 3800 may include a guide for managing how deep a surgeon cuts into the calcaneus 1806 using the cutting tool. In one embodiment, the depth may be recommended in a preoperative plan and a surgeon may configure the cutting tool to indicate when that depth is reached. Alternatively, or in addition, the resection guide 3820 may include a stop that prevents cutting below the recommended depth. For example, the resection guide 3820 may have a height that is such that a lateral side of the resection guide 3820 may serve as a stop to prevent cutting beyond a particular depth. Alternatively, or in addition, a separate structure may be provided with the osteotomy system 3800 and/or the resection guide 3820 to serve as a stop to control cutting depth into a bone.	486	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 39A illustrates the resection guide 3820 secured to the calcaneus 1806 by way of fasteners 2010a,b. A surgeon has created the osteotomy. The anterior bone fragment 1806a is separated from the posterior bone fragment 1806b. Advantageously, fastener 2010a engages with the anterior bone fragment 1806a and fastener 2010b engages with the posterior bone fragment 1806b. Thus, a surgeon can manipulate these bone fragments as needed. At this stage, a surgeon can remove the resection guide 3820 and the fasteners 2010 remain in the bone fragments.	487	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Referring now to Figure 39B, next, a surgeon may slide a positioning guide 3810 over fastener 2010a and fastener 2010b until the positioning guide 3810 contacts the anterior bone fragment 1806a and the posterior bone fragment 1806b. Figure 39B illustrates a positioning guide 3810a seated on the calcaneus 1806.	488	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The positioning guide 3810a may not include an offset feature 3808. Alternatively, or in addition, the positioning guide 3810a may include an offset feature 3808 in which the amount of offset is zero.	489	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 39C illustrates a stage in the surgical osteotomy procedure. The resection guide 3820 has been removed. The fasteners 2010 remain engaged with the bone fragments of the calcaneus 1806. An alternative embodiment of a positioning guide 2300 has been deployed. In contrast to the positioning guide 3810a illustrated in Figure 39B, Figure 39C illustrates a surgeon’s use of positioning guide 3810b. Positioning guide 3810b may include an offset feature 3808 having a non-zero amount of offset.	490	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In the illustrated embodiment, the action of sliding positioning guides 3810 on the fasteners 2010 can cause the posterior bone fragment 1806b to translate relative to the anterior bone fragment 1806a. This movement of bone fragments can be caused by an offset feature 3808 and/or by a configuration of the anterior alignment feature 3804 and/or the posterior alignment feature 3806.	491	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, the positioning guide 3810b can include an offset feature (translation feature) that facilitates positioning the posterior bone fragment 1806b with a desired (preplanned and/or patient-specific) translation, rotation, and/or orientation relative to the anterior bone fragment 1806a. In addition, in certain embodiments, one or more of the fasteners 2010 may permit rotation of one part of the bone in relation to another part or another landmark.	492	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 anterior alignment feature 3804 and the posterior alignment feature 3806 are configured to facilitate translation and/or rotation of one or more of the anterior bone fragment 1806a and the posterior bone fragment 1806b.	493	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, The alignment features 3804 may be embodied as a hole or opening that extends from one side to the other. The angle of the hole through the alignment feature may cause a desired translation and/or rotation of a bone fragment connected to a fastener 2010. Advantageously, the angle of the hole can be a patient-specific aspect designed as part of the osteotomy system 3800 and can be based, at least in part, on a bone model of a bone of a patient.	494	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 39C illustrates one embodiment of a positioning guide 3810b. In this embodiment, the posterior alignment feature 3806 is configured to rotate the posterior bone fragment 1806b dorsally by a predetermined and/or patient-specific angle, such as about 4 degrees. As the positioning guide 3810b slides over fastener 2010a and fastener 2010b, the posterior bone fragment 1806b slides medially and rotates dorsally.	495	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 39D illustrates an alternative embodiment of the positioning guide 3810b in which the posterior alignment feature 3806 is configured to rotate the posterior bone fragment 1806b dorsally by a predetermined and/or patient-specific angle, such as about 8 degrees. As the positioning guide 3810b slides over fastener 2010a and fastener 2010b, the posterior bone fragment 1806b slides medially and rotates dorsally.	496	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	One challenge with osteotomies is how to maintain control over one or more bone fragments throughout the surgical procedure. Advantageously, the fastener 2010a and fastener 2010b connected or coupled to the anterior bone fragment 1806a and/or posterior bone fragment 1806b enable a surgeon to maintain control over these bone fragments. With the osteotomy completed, a surgeon can then focus on positioning and/or reorienting bone fragments to remediate a bone condition of the patient.	497	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The positioning guides 3810 (e.g., positioning guide 3810a and/or positioning guide 3810b) are configured to engage with fastener 2010a and fastener 2010b such that the bone fragments connected to the fasteners remain connected, stable, and positioned in a desired position, until a surgeon takes steps to change the position. This stability can be very helpful to a surgeon to achieve a desired positioning and desired eventual patient outcome. In one embodiment, with the positioning guide 3810b seated and the bone fragments translated and/or rotated, a surgeon can confirm that the bone fragments are in a desired position. This may be done using medical imaging such as flouroscopy. Advantageously, the osteotomy system 3800 (e.g., positioning guide 3810b and fasteners 2010a,b) retains the bone fragments in the same position prior to, during, and after capturing imaging using flouroscopy. This can be a great help to a surgeon as their hands are free during the flouroscopy check and they are assured that the bone fragments have not moved during the flouroscopy check. The surgeon can have confidence that bone fragments are in a desired position and will maintain that position until either repositioned and/or fixation is deployed to secure the bone fragments in place. Such reliability and assurance can greatly assist a surgeon because once fixation is deployed, repositioning of the bone fragments may be very challenging and may lead to less than desirable outcomes. Therefore, a surgeon may strive to ensure that the bone fragments are in a desired position and maintain that position up until permanent fixation is deployed. The embodiments of the present disclosure provide this advantage to the surgeon.	498	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 39E illustrates a stage in the surgical osteotomy procedure. The positioning guide 3810b is seated and in place and a fixation guide 3890 can been coupled to fastener 2010a and fastener 2010b. In one embodiment, the fixation guide 3890 includes openings that are slid over the fastener 2010a and fastener 2010b. In one embodiment, a posterior opening that receives fastener 2010b may be oversized and/or in a slot shape to account for different angles of rotation that a positioning guide 3810b may use in the osteotomy system 3800.	499	Added by DJM Jan 2024	1/6/24, 10:03 PM

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