Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Application	Content	Paragraph Number	Notes	Modified
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View Edit Delete	PER-32	In addition, a surgeon can designate which sides of the resection features 1022 are open and/or closed. In one embodiment, a surgeon can indicate that they want to make a single cut or resection in order to perform an opening wedge procedure. Alternatively, or in addition, the surgeon may indicate whether the opening wedge will be filled with a graft such as an allograft. Using a model and/or a preoperative plan, the size of an allograft can be determined preoperatively and the allograft and/or an implant, to be placed into an opening wedge, can be determined and/or fabricated prior to the surgical procedure. Alternatively, or in addition, the allograft and/or an implant can be sized to precise dimensions provided in a preoperative plan during the operation, for example on a back table. The size and shape of the allograft and/or an implant can be predefined to achieve a desired erectus disposition for the anatomy of the patient.	169	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	FIGS. 11A-11D illustrate views of an example resection guide 1020a of the system 1000 of FIG. 10, according to one embodiment. The resection guide 1020a includes a single resection feature 1022, one or more bone attachment features 1024, and/or one or more bone engagement surfaces 1026. In certain embodiments, the resection guide 1020a may include one or more landmark registration features 1028. Other embodiments may not include landmark registration features 1028. The resection guide 1020 includes a body 1032 that supports the resection feature 1022, one or more bone attachment features 1024, and/or one or more bone engagement surfaces 1026.	170	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	The body 1032 may include a resection feature 1022 that guides a cutting tool to resect one or more bones, such as a distal tibia in the manner needed to make the desired resection. For example, the resection features 1022 may be used to guide a planar cutting blade, an arcuate cutting blade, a drill or mill, a burr, and/or the like. The resection features 1022 may guide a reciprocating planar blade, such as that of a surgical bone saw, which forms planar cuts in a distal tibia. 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 feature 1022 may take the form of a single slot 1052 in a “V” shape.	171	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	The body 1032 may include a pattern 1033 of openings that extend from one surface or side to an opposite surface or side. In the illustrated embodiment, the pattern 1033 is a honeycomb pattern of holes in the shape of hexagons. The pattern 1033 serves to enhance visualization by a surgeon of bone contacting the resection guide 1020. In addition, the pattern 1033 reduces the amount of material needed to fabricate the resection guide 1020. In certain embodiments, the resection guide 1020 may be fabricated from metal using additive manufacturing. Furthermore, the pattern 1033 provides an aesthetic benefit for the resection guide 1020.	172	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	The resection guide 1020 includes an anterior side 1034, a posterior side 1036, a medial side 1038, a lateral side 1040, a superior side 1042, and an inferior side 1044. FIG. 11A is an inferior perspective view. FIG. 11B is a superior perspective view. FIG. 11C is lateral side perspective view. FIG. 11D is a medial side perspective view.	173	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	In one embodiment, the resection guide 1020 may include an alignment guide 1046. The alignment guide 1046 may be a part of, connected to, or extend from the body 1032 or may be a separate component. The alignment guide 1046 serves as a guide to orient the resection guide 1020 relative to a longitudinal axis of a bone. In the illustrated embodiment, the alignment guide 1046 includes a structure that extends from the medial side 1038 and includes a hole sized to accept and retain a fastener 1010 such as a K-wire. The hole is positioned such that with a K-wire in the hole, a surgeon can align the K-wire with a longitudinal axis of a bone, such as a tibia to ensure that the features of the resection guide 1020 are aligned relative to the longitudinal axis of the bone.. The alignment guide 1046 assists a surgeon in desired placement and orientation of the resection guide 1020 during a surgical procedure.	174	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	In one embodiment, the single slot 1052 extends from the medial side 1038 to the lateral side 1040. In certain embodiments, the single slot 1052 may extend from near the anterior side 1034 to near the posterior side 1036 and then back to near the anterior side 1034 to form a “V” shape with an apex of the “V” being near the posterior side 1036.	175	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	As mentioned previously, the method 120 is one species of the method 100; the present disclosure encompasses many different procedures, performed with respect to many different bones and/or joints of the body. Exemplary steps and instrumentation for the method 120 will further be shown and described in connection with the present disclosure. Those of skill in the art will recognize that the method 120 may be used in connection with different instruments; likewise, the instruments of the present disclosure may be used in connection with methods different from the method 100 and the method 120.	81	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	FIG. 2A is a perspective dorsal view of a foot 200. The foot 200 may have a medial cuneiform 202, an intermediate cuneiform 204, lateral cuneiform 206, a first metatarsal 208, a second metatarsal 210, third metatarsal 212, fourth metatarsal 214, fifth metatarsal 216, navicular 218, cuboid 220, and calcaneus 222, among others. The medial cuneiform 202 and the intermediate cuneiform 204 may be joined together at a first metatarsocuneiform joint, and the first metatarsal 208 and the second metatarsal 210 may be joined together at a second metatarsocuneiform joint.	82	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	FIG. 2B is a perspective lateral view of a foot 200, with bones of the foot labeled.	83	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	FIG. 2C is a perspective lateral view of a foot illustrating a dorsal side 280 and a plantar side 282. Dorsal refers to the top of the foot. Plantar refers to the bottom of the foot. Proximal 284 is defined as “closer to the primary attachment point”. Distal 286 is defined as “further away from the attachment point”. Plantarflex or plantarflexion 288 means movement toward the plantar side 282 of a foot or hand, toward the sole or palm. Dorsiflex or dorsiflexion 290 means movement toward the dorsal side 280 of a foot or hand, toward the top. FIG. 2D is a perspective dorsal view of the foot 200. A transverse plane is the plane that shows the top of the foot. A lateral side 292 means a side furthest away from the midline of a body, or away from a plane of bilateral symmetry of the body. A medial side 294 means a side closest to the midline of a body, or toward a plane of bilateral symmetry of the body. For a Lapidus procedure, the intermetatarsal (IM) angle 296 is the angle to be corrected to remove the hallux valgus (bunion) deformity.	84	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	Every patient and/or condition is different; accordingly, the degree of angular adjustment needed in each direction may be different for every patient. Use of a patient-specific guide may help the surgeon obtain an optimal realignment, target, or position a bone tunnel, position one or more resections and/or fasteners and the like. Thus, providing patient-specific guides, jigs, and/or instrumentation may provide unique benefits.	85	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	The present patient-specific instrumentation may be used to correct a wide variety of bone conditions. Such conditions include, but are not limited to, any angular deformities from within one bone segment in either the lower or upper extremities (for example, tibial deformities, calcaneal deformities, femoral deformities, and radial deformities). The present disclosure may also be used to treat an interface between two bone segments (for example, the ankle joint, metatarsal cuneiform joint, lisfranc's joint, complex Charcot deformity, wrist joint, knee joint, etc.). As one example, an angular deformity or segmental malalignment in the forefoot may be treated, such as is found at the metatarsal cuneiform level, the midfoot level such as the navicular cuneiform junction, hindfoot at the calcaneal cuboid or subtalar joint or at the ankle between the tibia and talar junction. Additionally, patient-specific instruments could be used in the proximal leg between two bone segments or in the upper extremity such as found at the wrist or metacarpal levels.	86	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	FIG. 3 illustrates a flowchart diagram depicting a method 300 for generating one or more patient-specific instruments configured to correct or address a bone or foot condition, according to one embodiment. Prior to steps of the method 300, a bone model (also referred to as CAD model above) is generated. The bone model may be generated using medical imaging of a patient’s foot and may also be referred to as an anatomic model. The medical imaging image(s) may be used by computing devices to generate patient imaging data. The patient imaging data may be used to measure and account for orientation of one or more structures of a patient’s anatomy. In certain embodiments, the patient imaging data may serve, or be a part of, anatomic data for a patient.	87	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	In one embodiment, the method 300 begins after a bone model of a patient’s body or body part(s) is generated. In a first step 302, the method 300 may review the bone model and data associated with the bone model to determine anatomic data of a patient’s foot.	88	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	After step 302, the method 300 may determine 304 a recommended location and/or a trajectory angle and/or patient-specific features for a procedure using the anatomic data. "Recommended location" refers to a location for deployment of guide or instrument on, in, between, or within one or more body parts (e.g., bones) of a patient. "Trajectory angle" refers to a recommended angle for deployment of an instrument, graft, body part, or resection feature angle relative to a bone of a patient for a procedure. In certain embodiments, determining the recommended location may employ advanced computer analysis system, expert systems, machine learning, and/or automated/artificial intelligence. In another embodiment, the method 300 may include determining one or more alternative locations and/or trajectory angles for tendon deployment.	89	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	Next, the method 300 may proceed and a preliminary guide model is provided 306 from a repository of template tendon trajectory models. A preliminary guide model is a model of a preliminary guide.	90	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	As used herein, "preliminary guide" refers to a guide configured, designed, and/or engineered to serve as a template, prototype, archetype, or starting point for creating, generating, or fabricating a patient-specific guide. In one aspect, the preliminary guide may be used, as-is, without any further changes, modifications, or adjustments and thus become a patient-specific guide. In another aspect, the preliminary guide may be modified, adjusted, or configured to more specifically address the goals, objectives, or needs of a patient or a surgeon and by way of the modifications become a patient-specific guide. The patient-specific guide can be used by a user, such as a surgeon, to guide steps in a surgical procedure, such as an osteotomy and/or a tendon transfer procedure. Accordingly, a preliminary guide model can be used to generate a patient-specific guide. The patient-specific guide model may be used in a surgical procedure to facilitate one or more steps of the procedure, and may be used to generate a patient-specific guide that can be used in a surgical procedure for the patient.	91	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	In certain embodiments, the preliminary guide model may be generated based on anatomic data and/or a bone model or a combination of these, and no model or predesigned structure, template, or prototype. Alternatively, or in addition, the preliminary guide model may be, or may originate from, a template guide model selected from a set of template guide models. Each model in the set of template guide models may be configured to fit for an average patient’s foot. The template guide model may subsequently be modified or revised by an automated process or manual process to generate the preliminary guide model used in this disclosure.	92	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	As used herein, "template guide" refers to a guide configured, designed, and/or engineered to serve as a template for creating, generating, or fabricating a patient-specific guide. In one aspect, the template guide may be used, as-is, without any further changes, modifications, or adjustments and thus become a patient-specific guide. In another aspect, the template guide may be modified, adjusted, or configured to more specifically address the goals, objectives, or needs of a patient or a surgeon and by way of the modifications become a patient-specific guide. The patient-specific guide can be used by a user, such as a surgeon, to guide making one or more resections of a structure, such as a bone for a procedure. Accordingly, a template guide model can be used to generate a patient-specific guide model. The patient-specific guide model may be used in a surgical procedure to address, correct, or mitigate effects of the identified deformity and may be used to generate a patient-specific guide that can be used in a surgical procedure for the patient.	93	Added by DJM Jan 2024	1/6/24, 9:48 PM

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