Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Application	Content	Paragraph Number	Notes	Modified
		Content		Paragraph Number	Notes	Any Field
View Edit Delete	PER-12	As also shown in Figure 24A, method 2400 may include removing the wedge bone fragment by way of the first fastener and the second fastener (block 2416). For example, a surgeon may remove the wedge bone fragment by way of the first fastener and the second fastener, as described herein.	407	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	As further shown in Figure 24A, method 2400 may include sliding a positioning guide over the posterior pin and the anterior pin by passing the posterior pin through a posterior alignment feature and passing the anterior pin through an anterior alignment feature (block 2418). For example, a surgeon may slide a positioning guide over the posterior pin and the anterior pin by passing the posterior pin through a posterior alignment feature and passing the anterior pin through an anterior alignment feature, as described herein.	408	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	As also shown in Figure 24A, method 2400 may include sliding the positioning guide along the posterior pin and anterior pin until the positioning guide contacts the posterior bone fragment and the anterior bone fragment (block 2420). For example, a surgeon may slide the positioning guide along the posterior pin and anterior pin until the positioning guide contacts the posterior bone fragment and the anterior bone fragment, as described herein.	409	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	As further shown in Figure 24A, method 2400 may include deploying fixation across an osteotomy between the posterior bone fragment and the anterior bone fragment (block 2422). For example, a surgeon may deploy fixation across an osteotomy between the posterior bone fragment and the anterior bone fragment, as described herein.	410	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figures 24B-24G illustrates different stages of performing a surgical osteotomy procedure (e.g., a Dwyer osteotomy) using certain embodiments of the osteotomy system 2000 and/or the method 2400, according to one embodiment. Typically, a preferred approach for a Dwyer osteotomy is on the lateral side of the calcaneus 1806. In the illustrated embodiment, the surgical procedure creates a wedge osteotomy. According to one embodiment, a surgeon may access a lateral surface of the calcaneus 1806 (block 2402, Figure 24A).	411	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Next a surgeon may position a resection guide 2020 such as resection guide 2020a 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 2020 to a surface of the calcaneus 1806 (a bone). The resection guide 2020 may be configured, for example, as one of the embodiments described herein.	412	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 2010 into a first bone attachment feature 2024a and a second fastener into second bone attachment feature 2024b such that the first fastener and second fastener are parallel relative to each other and enter a portion of the calcaneus that will form a wedge bone fragment. (block 2406)	413	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 24B illustrates the resection guide 2020a secured to the calcaneus 1806 by way of fasteners 2010. Figure 24C illustrates the resection guide 2020b (an alternative embodiment, fasteners 2010 omitted) positioned on a calcaneus 1806 of a foot.	414	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Next, a surgeon may insert a cutting tool into a posterior resection feature 2022a and an anterior resection feature 2022b and form a wedge bone fragment 2050. (blocks 2408 and 2410). In certain embodiments, the osteotomy system 2000 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 2020 may include a stop that prevents cutting below the recommended depth. For example, the resection guide 2020 may have a height 2106 that is such that the lateral side 2030 of the resection guide 2020 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 2000 and/or the resection guide 2020 to serve as a stop to control cutting depth into a bone.	415	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Next, a surgeon may engage a posterior pin guide 2202 with the posterior resection feature 2022a and an anterior pin guide 2204 with the anterior resection feature 2022b. in addition, the surgeon may deploy a posterior pin 2220 into the posterior pin guide 2202 and an anterior pin 2222 into the anterior pin guide 2204. (block 2412)	416	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 24D illustrates a stage in the surgical osteotomy procedure (e.g., a Dwyer osteotomy) in which a wedge resection has been performed. The wedge bone fragment 2050 is not shown for clarity. The pin guides 2200 include the posterior pin 2220 and the anterior pin 2222 (because these pins serve to engage a posterior bone fragment 2114 and an anterior bone fragment 2116 of the calcaneus 1806 after the resection and/or for subsequent repositioning of the bone fragments of the calcaneus 1806.	417	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 24E illustrates a closer view of the stage in the surgical osteotomy procedure (e.g., a Dwyer osteotomy) of Figure 24D. Note that in certain embodiments, the wedge cut from the bone may not extend to the opposite side of the bone. Instead approximately a 1-3 mm section of bone can be left on the other side of the bone from the osteotomy. This section can facilitate handling of the bone fragments of the calcaneus 1806 during the surgical osteotomy procedure (e.g., a Dwyer osteotomy). In certain embodiments, this remaining portion can be used as a living hinge to keep the two bone fragments together during a fixation step or during one or more steps of the surgical osteotomy procedure. In one embodiment, for example where a surgeon plans to rotate one bone fragment in relation to the other, the method 2400 may further include breaking a medial cortex 2110 opposite a wedge bone fragment 2050. Now, with the bone fragments separated, a surgeon may translate a posterior pin 2220 within a posterior alignment feature 2306 of a positioning guide 2300 to rotate a posterior bone fragment 2114 to a position determined by a surgeon to remediate a condition of the patient’s foot. For example, a surgeon may seek to achieve rectus alignment for a patient's foot, this may include structural realignment of the calcaneus 1806 from a calcaneal varus or valgus deformity to a rectus alignment. The ability to translate and/or rotate the posterior bone fragment 2114 in relation to the anterior bone fragment 2116 enables such repositioning and correction.	418	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 24F illustrates a cross section view from an inferior side of the calcaneus 1806 looking upward. Figure 24F includes the resection guide 2020a of Figure 21D taken along a line along an anterior-posterior direction through the resection guide 2020a, a posterior pin guide 2202, anterior pin guide 2204, posterior pin 2220, and anterior pin 2222.	419	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 24F illustrates that the resection guide 2020a can be configured to resect a particular shape from the bone, such as a wedge shape. Furthermore, the resection guide 2020a can be configured to resect a shape specific and unique to a particular patient. Said another way, the dimensions of the wedge bone fragment 2050 can be patient-specific.	420	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Advantageously, resection features 2022 of the resection guide 2020a can be configured to enable a surgeon using a cutting tool to separate the resected bone (e.g., wedge bone fragment 2050) from the patient bone (e.g., calcaneus 1806) while leaving in a part of the bone on the medial side, the medial cortex 2110. Advantageously, bone attachment features 2024 can be positioned within a perimeter of the resection features 2022 of the resection guide 2020a. Having the bone attachment features 2024 within the perimeter of the of the lateral side of the resection guide 2020a can provide secure engagement of a resected part (e.g., a wedge bone fragment 2050) of the bone once resection is complete. This can facilitate removal and/or repositioning of the wedge bone fragment 2050. In addition, fasteners 2010 used together with the bone attachment features 2024 can extend perpendicular to a surface of the resection guide 2020a and/or parallel to each other which can then facilitate removal of the resection guide 2020a after forming one or more osteotomies. Alternatively, or in addition, bone attachment features 2024 within the perimeter of the lateral side of the resection guide 2020a can facilitate minimally invasive surgery (MIS) procedures because this positioning of the bone attachment features 2024 can enable the resection guide 2020 to be smaller in size.	421	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 24F illustrates that one or more resection features 2022 of the resection guide 2020a can be used to position additional fasteners that can be used later in an osteotomy procedure to reposition bone or bone parts of the patient (e.g., parts of the calcaneus 1806). In Figure 24F, a first osteotomy and a second osteotomy have been performed and a bone wedge fragment is connected to the one or more fasteners 2010 but separated from the calcaneus 1806.	422	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, an arm 2206 of a pin guide 2200 can be placed into a resection feature 2022 at a predefined position. The arm 2206 may extend at a predefined distance and/or angle such that a fastener 2010 inserted through a hole 2214 near one end of the arm 2206 will engage the bone (e.g. calcaneus 1806) or part of a bone at a desired position and/or angle. Advantageously, even though the fasteners 2010 may engage the bone, calcaneus 1806, at a variety of angles, the pin guides 2200 may be separate components such that they can be readily removed as the osteotomy procedure (e.g., wedge osteotomy procedure) proceeds to subsequent steps. Of course, in certain embodiments, the pin guides 2200 may be integrated with the resection guide 2020. Separate pin guides 2200 may be desirable to facilitate removal of the resection guide 2020 and/or pin guides 2200 during a procedure.	423	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, it may be desirable to position the fasteners 2010 within the pin guides 2200 and relative to each other such that the fasteners 2010 are aligned in an anterior to posterior direction. In this manner, the original position of the parts of the bone (e.g. calcaneus 1806) can be maintained and used for subsequent steps of the osteotomy procedure (e.g., wedge osteotomy procedure).	424	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	After the stage illustrated in Figure 24E, a surgeon may remove the posterior pin guide 2202, anterior pin guide 2204, and the resection guide 2020. (block 2414) Then, a surgeon may remove the wedge bone fragment 2050 using, for example, the one or more fasteners 2010. (block 2416) Then, a surgeon may slide a positioning guide 2300 over the posterior pin 2220 and the anterior pin 2222 until the positioning guide 2300 contacts the posterior bone fragment 2114 and the anterior bone fragment 2116. (block 2420) In certain embodiments, this action of sliding the positioning guide 2300 to contact bone fragments can cause the osteotomy to be reduced and/or can cause the bone fragments to be translated and/or rotated relative to each other.	425	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 24G illustrates a stage in the surgical osteotomy procedure (e.g., a Dwyer osteotomy) of Figure 24E. The resection guide 2020a and pin guides 2200 have been removed. The additional fasteners 2012 in the pin guides 2200 remain engaged with the calcaneus 1806. A positioning guide 2300 has been deployed. In certain embodiments, a medial cortex 2110 opposite the osteotomy may be broken by a surgeon (e.g., manually). Alternatively, or in addition, the resection guide 2020a can be configured to enable resection through the bone to the medial surface 2108 of the calcaneus 1806.	426	Added by DJM Jan 2024	1/6/24, 10:03 PM

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