Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Application	Content	Paragraph Number	Notes	Modified
		Content		Paragraph Number	Notes	Any Field
View Edit Delete	PER-32	Thus, upon desired positioning of the resection guide 1020 (using one or more of the bone engagement surface 1026, alignment guide 1046 and/or the landmark registration features 1028) a surgeon may engage two or more of the bone attachment features 1024 to secure the resection guide 1020 in place on the bone. This positioning places the single slot 1052 in the desired position for forming a resection wedge in the bone to guide resection of the bone during a surgical osteotomy for correcting a condition.	176	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	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.	177	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	Alternatively, or in addition, in certain embodiments, one or both of, the resection feature 1022 may be positioned on, or in, the body 1032 and/or have an orientation based on patient imaging data. The patient imaging data can be used to position and orient the resection feature 1022 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 1026, a position for a single slot 1052, an orientation for the single slot 1052, as well as other features and attributes of one or more patient specific instruments that can be used in a procedure.	178	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	The resection guide 1020 includes one or more bone attachment features 1024. As embodied in FIGs. 11A through 11E, the bone attachment features 1024 may take the form of one or more holes 1056 that extend from the medial side 1038 to the lateral side 1040 and/or one or more fixation devices. The holes 1056 may be shaped to accommodate pins, K-wires, and/or other elongated bone fixation elements that can be anchored in a bone to keep the resection guide 1020 in place.	179	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	In the illustrated embodiment, the superior side 1042 includes a proximal bone attachment feature 1058 and the inferior side 1044 includes a distal bone attachment feature 1060. In one embodiment, the holes 1056 of the proximal bone attachment feature 1058 are aligned with each other. Alternatively, or in addition, the proximal bone attachment feature 1058 are not aligned with each other.	180	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	In certain embodiments, the proximal bone attachment feature 1058 and/or distal bone attachment feature 1060 may be aligned with a corresponding resection feature 1022. In one embodiment, the holes 1056 of the proximal bone attachment feature 1058 may be parallel to at least part of the resection feature 1022.	181	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	The landmark registration feature 1028 serves to facilitate registration of a guide 1020 to a surface of a bone and/or to one or more landmarks of one or more bones. In one embodiment, the landmark registration features 1028 can be configured to engage a cortical surface of a bone. The resection guide 1020 can include one, two, or more landmark registration features 1028. In the illustrated embodiment, the resection guide 1020 may include two landmark registration features 1028. The landmark registration features 1028 can extend from one or more sides of the resection guide 1020. In the illustrated embodiment, the landmark registration features 1028 extend from the anterior side 1034 and/or the posterior side 1036. Those of skill in the art will appreciate that the landmark registration features 1028 can have various lengths, widths, and thicknesses. Advantageously, the landmark registration features 1028 can also include a bone engagement surface 1026 that may extend a bone engagement surface 1026 on bone engagement surface 1026 of the resection guide 1020.	182	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	Advantageously, the landmark registration feature 1028 can provide a surgeon with confidence and assurance in the placement and positioning of the resection guide 1020 on a bone because the landmark registration feature 1028 can be configured to engage with a particular landmark on the bone or other patient anatomy (e.g., a projection or a depression or cavity). Alternatively, or in addition, the landmark registration feature 1028 can include a contoured bone engagement surface that can further facilitate registration of the landmark registration feature 1028 and/or guide 1020 with the bone. In this manner, a surgeon can be assured intraoperatively that the resection guide 1020 is positioned in accordance with a preoperative plan.	183	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	In certain embodiments, the landmark registration feature 1028 can be shaped like a hook to engage a surface of bone. Alternatively, or in addition, the resection guide 1020 may include a landmark registration feature 1028 on different sides, together the landmark registration features 1028 can engage one or more landmarks of a surface of the bone such that the surgeon can accurately position and register the resection guide 1020 to the bone.	184	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	FIG. 11E illustrates a resection guide 1020d that, like resection guide 1020a, includes a single resection feature 1022. In the illustrated embodiment, the resection guide 1020d may include one or more stops 1047. The stop 1047 serves to prevent resection beyond a certain, point, line, or plane.	185	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	In the illustrated embodiment, the stop 1047 may take the form of an opening at a particular position within the resection feature 1022. For example, the stop 1047 may be positioned at a vertex of the single slot 1052. The stop 1047 may be embodied as a hole 1048 that extends from one side of the resection guide 1020 to the other and a fastener 1050 configured to fit within that hole 1048.	186	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	In one example, a k-wire can be placed in a hole in the vertex to implement the stop 1047. In this manner, the stop 1047 prevents resection beyond that vertex of the resection feature 1022. The stop 1047 may be so positioned to assist a surgeon in maintaining a cortical section of bone on one side of the bone. In the illustrated embodiment, the stop 1047 prevents a resection by a cutting tool in the posterior direction in the bone, such as a distal tibia, which can preserve a section of cortical bone on the posterior side of the bone. This preserved bone (e.g., preserved posterior cortex) can serve as a living hinge once a wedge section is resected. The stop 1047 can serve as a cutting guide to prevent resection of areas during a procedure.	187	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	As an example, a surgeon may position the resection guide 1020d, secure the resection guide 1020d to one or more bones using the bone attachment features 1024. Next, a surgeon may deploy a pin or K-wire in a hole of the stop 1047 to engage with the bone. As the surgeon resects, the K-wire prevents resection beyond the vertex of the resection feature 1022.. The K-wire blocks the cutting tool from cutting farther than intended.	188	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	Those of skill in the art will appreciate that a resection guide 920 may include one or more bone attachment features 1024. Certain bone attachment features 1024 may be positioned to engage with a resected segment, wedge, or bone fragment and other bone attachment features 1024 may engage with remaining bones or bone segments after resection. Furthermore, the resection guide 920, such as example resection guide 1020, may include bone attachment features 1024 that are strategically positioned in the resection guide 920 to serve a trajectory guides, attachment points, compression anchors, distraction anchors, reduction guides, stops, cutting guides, or the like. For example, bone attachment features 1024 and the pins that can be deployed within the can be strategically placed in a way that following the wedge resections, the pins can then be manipulated to aid in the reduction /correction using specialized instrumentation and/or customized instrumentation, segmental compression blocks, or other complementary components 930.	189	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	In addition, the bone attachment features 1024 and associated pins can be designed, positioned, oriented, and utilized to target provisional and/or permanent fixation devices such as pins, staples, screws, bolts, beams, nail or strategically placed reduction wires that can be utilized for external devices such as external fixators.	190	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	Furthermore, customized guides can be placed over strategically placed pins used with bone attachment features 1024 and these pins can be used for the purposes of pre-drilling fixation components such as screws or strategic placement of fixation, plates, staples, etc.	191	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	FIG. 11E illustrates a medial side view of patient-specific guide 1020d according to one embodiment. FIG. 11E also illustrates a three-dimensional axis 1100. The three-dimensional axis 1100 includes a cephalad-caudal axis 1102, a medial-lateral axis 1104, and an anterior-posterior axis 1106.	192	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	FIGs. 11E illustrate the position and/or angle (e.g., orientation) of one a resection feature 1022 (e.g., single slot 1052) based on patient imaging data. In the illustrated embodiment, the single slot 1052 is positioned with a first side 1108 perpendicular to a longitudinal axis of the bone (e.g., a tibia) and a second side 1110 offset from the first side by an angle B. Advantageously, the angle B is determined by a surgeon in a prescription and/or preoperative plan that were used to fabricate the resection guide 1020. The angle B is defined to overcome a condition of the patient and can range between about 1 degree and about 80 degrees. Advantageously, the patient imaging data can be used to recommend a correction angle for angle B, that a surgeon can confirm or adjust as needed.	193	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	In the illustrated embodiment, the single slot 1052 is angled relative to the anterior-posterior axis 1106. In the illustrated embodiment, the second side 1110 extends caudally from the anterior-posterior axis 1106 at a desired angle, labeled angle B. This orientation and configuration for the single slot 1052 can be used to form an anterior closing wedge in a distal end of a tibia by resecting from a medial side.	194	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	Similarly, those of skill in the art will appreciate that just as the angle B for one or more resection features 1022 can be predefined and determined, the orientation of one or more holes 1056 of one or more bone attachment features 1024. In one embodiment, a hole 1056 of the distal bone attachment feature 1060 may extend into the body at the same, or a similar, angle as angle B. The angled holes 1056 cause the fasteners 1010 to enter the bone at substantially the same angle as the hole extends into the body 1032. Where one or more holes 1056 extend into the body 1032 at an angle other than perpendicular, one or more fasteners 1010 in the holes 1056 may need to be removed in order to remove a resection guide 1020 once resection cuts are completed. In one embodiment, one or more holes 1056 of the proximal bone attachment feature 1058 may be oriented perpendicular to a bone surface and/or perpendicular to a longitudinal axis of a bone used with the resection guide 1020.	195	Added by DJM Jan 2024	1/6/24, 9:49 PM

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