Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-24	In another embodiment, a resection feature (e.g., first resection feature 1864 and/or second resection feature 1866) can be implemented by way of a slot that has a curve, or curved, shape. The resection feature may extend into a body of a resection guide 1820 from one side and out an opposite side and the resection feature includes a first end and a second end. The resection feature may have a curve or curved shape between the first end and the second end. Such a resection feature is referred to herein as a curved slot. In one embodiment, the curved slot may have a curved cross section similar to the curve shape illustrated in the example first resection feature 1864 and/or second resection feature 1866. In one embodiment, a surgeon may insert a cutting tool such as a burr into bone through a curved slot and follow a path between the first end and the second end of the curved slot to resect a curved osteotomy.	377	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Alternatively, or in addition, a single resection guide 1820 may include a pair of resection features. A first resection feature can include a plurality of openings in a curved shape with a few millimeters between them along the arc of the curve. A surgeon may first form holes in bone using each of the openings of the first resection feature. Next, a surgeon may replace the first resection feature with a second resection feature. The second resection feature may include a plurality of openings that are offset from the holes of the first resection feature. The offset holes enable a surgeon to form holes or tunnels in the bone that are adjacent to and may interconnect with the holes formed using the first resection feature. In this manner, a surgeon can accurately form a curved osteotomy (and/or an angled curved osteotomy) in the bone. In one embodiment, the first resection feature and second resection feature may be interchangeable by way of a coupler.	378	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Referring now to FIGs. 2E, 18, and 19A-G, a first resection guide 1822 includes a first resection feature 1864. The first resection feature 1864 is configured to guide a cutting tool for form a curved osteotomy. The curved osteotomy is curved when viewed and/or measured within a sagittal plane 262 of an ankle of a patient. In particular, the curved osteotomy is formed by a pattern of a plurality of openings arranged in a curve within the body of the first resection guide 1822. In the illustrated embodiment, the pattern is a downward curve shape. Where the first resection guide 1822 is used on a proximal end of a bone, this pattern results in a convex curve shape on the end of the bone resected using the first resection guide 1822.	379	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	The curved osteotomy is determined, at least partially, based on a bone model of at least a portion of the patient's ankle. The bone model is based on medical imaging of the patient's ankle. A curve osteotomy is an osteotomy that has a curve shape that starts on one end and includes at least one arc and ends at another end.	380	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In the illustrated embodiment, by forming a bone tunnel in the bone aligned with each of the plurality of openings in the first resection feature 1864, and then interconnecting the bone tunnels, a curved shape (like a dome) can be formed on an end or within a bone of a patient. The bone tunnels can be interconnected by angling a burr cutting tool within one opening in one direction and/or the other (e.g., medially and/or laterally). In one embodiment, the openings of the plurality of openings have a diameter that permits a burr cutting tool to be moved in a way to interconnect bone tunnels. Alternatively, or in addition, the bone tunnels can be interconnected by using an osteotome to remove walls between adjacent bone tunnels.	381	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Referring now to FIGs. 2E, 18, and 20A-G, in the illustrated embodiment, a second resection guide 1824 includes a second resection feature 1866. The second resection guide 1824 is configured to guide a cutting tool to form an angled curved osteotomy. The angled curved osteotomy is similar to a curved osteotomy in that the angled curved osteotomy is curved when viewed and/or measured within a sagittal plane 262 of an ankle of a patient.	382	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In addition, an angled curved osteotomy extends into a bone at an angle that is not perpendicular to a long axis (e.g., mechanical axis 880 of a bone). In the illustrated embodiment, the angled curved osteotomy may extend into a tibia at first angle 1896 that is not perpendicular to a long axis of the tibia 226 (e.g., mechanical axis 880 of the tibia 226). In one embodiment, the first angle 1896 is measured within a frontal plane 264. In particular, the first angle 1896 can be measured in relation to a horizontal medial-lateral axis ML within the frontal plane 264. In certain embodiments, the first angle 1896 can range from 1 degree to 88 degrees and can be extend from the ML axis in either a dorsal direction or a plantar direction.	383	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In addition, the ability to define resection features 826 preoperatively can enable a surgeon to resect one or more malleoli of a patient to achieve a desired surgical procedure outcome. For example, the resection guides 820 can be used to resect the malleoli of a patient such that translational/rotational correction in one joint or foot match another joint or foot or extremity more precisely.	285	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In the illustrated embodiment, the resection feature 826a extends in a plantar direction away from a medial-lateral axis 882 at an angle A measured in degrees. The angle A may range from 1 degree to 60 degrees. A surgeon may designate and/or revise the magnitude of angle A, until the result of the osteotomies using angle A will provide a desired level of correction as determined by the surgeon. In certain embodiments, the osteotomy system 800 may include a proposed magnitude for angle A, that a surgeon can then revise as needed or desired.	286	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In the illustrated embodiment, the resection feature 826a may extend at angle A in relation to the medial-lateral axis 882 and guide a cutting tool perpendicular to a mechanical axis 880 of the tibia 226. The medial-lateral axis 882 runs in the transverse plane 266 perpendicular to the mechanical axis 880 of the tibia 226.	287	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Once a first osteotomy is performed using resection feature 826 of the tibial resection guide 822 and a second osteotomy is performed using the resection feature 826 (e.g., 826a, 826b) of the talus resection guide 824, a surgeon can then reduce the osteotomies. When a surgeon reduces the osteotomies and abuts the first osteotomy against the second osteotomy, the reduced osteotomies remediate a deformity of the patient. The tibia 226 and talus 222 can now fuse to complete the arthrodesis. It should be noted that in the illustrated embodiment the position, alignment, orientation, and/or trajectories for the resection features 826 are selected for an arthrodesis, no implants will be used between the first osteotomy and the second osteotomy.	288	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	FIG. 12B illustrates a resection interface 884 (see dashed oval). Prior to the osteotomies, the resection interface 884 can include a distal end of the tibia 226 and a proximal end of the talus 222. Once the osteotomies are performed, the resection interface 884 can include the resected surfaces on the distal end of the tibia 226 and a proximal end of the talus 22. Once the osteotomies are reduced, the resection interface 884 includes the resected surfaces abutting each other. Those of skill in the art will appreciate that for a given arthrodesis, ankle fusion procedure, the configuration of the osteotomies can be varied based on the experience level and/or desires of the surgeon in order to accomplish a successful fusion. Furthermore, the space between osteotomies and other structures of the ankle that a surgeon desires to preserve can be limited and thus require extra care. Advantageously, the present disclosure includes aspects to assist with accomplishing the desired osteotomies and preserving the surrounding structures. In one embodiment, these aspects can include one or more resection guards 870 and/or one or more stops. In certain embodiments, a resection guard 870 can serve as a stop.	289	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In certain embodiments, the osteotomy system 800 may include one or more resection guards 870. A resection guard 870 is a structure, device, part, component, or apparatus designed and/or positioned to mitigate or prevent resection beyond a particular point or boundary. The resection guard 870 can and/or does help a surgeon limit resection within a certain area of the bone as guided by a resection feature 826 and resection guard 870. In the illustrated embodiment, fasteners 810 may cooperate with the resection features 826 and/or openings in the resection features 826 to serve as both fasteners and as resection guards 870. Alternatively, or in addition, other structures may be used to serve as resection guards 870. In one embodiment, the fasteners 810 and/or resection guards 870 can be strategically positioned in the resection guides 820 and/or configured (e.g., having a particular length) such that the fasteners 810 and/or resection guards 870 also retain or retract soft tissue around an opening formed for performing the osteotomy.	290	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Advantageously, the resection guards 870 provide a boundary within the respective bones to prevent a cutting tool from drifting, or moving, outside an area defined by a resection feature 826. Resection of the talus 222 and/or tibia 226 can require deep cuts and keeping the cutting tool within the area defined by the resection feature 826 can be a challenge as the resection extends deeper and deeper into a bone. Advantageously, the resection guards 870 can assist the surgeon to avoid inadvertent resection of structures near or adjacent to the area indicated by the resection feature 826 (e.g., medial malleolus, lateral malleolus, etc.). In this manner, resection guards 870 can be a form of stop used in the osteotomy system 800.	291	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	As an osteotomy is performed in the resection feature 826 a surgeon may have limited to no information about how deep the osteotomy is extending into the bone. Of course, a surgeon can check depth using medical imaging such as fluoroscopy, however this can add time and expense to a procedure. In one embodiment, a preoperative plan included in the osteotomy system 800 can identify the width and length of cutting tool, such as a saw for a surgeon to use for each of the osteotomies. The saw may include laser etch depth markings on the blade such that as the blade enters a surgeon can read the depth from the blade. Alternatively, or in addition, the present disclosure can provide one or more stops to assist a surgeon in managing depth of the osteotomy.	292	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Based on the surgical procedure to be performed, many decisions about the design and/or make up of the patient-specific osteotomy system 606 can be made as recommendations and/or proposals by a technician to a surgeon. These decisions can be based in whole or in part on the surgical procedure to be performed, the bone model 404 and/or the user instructions 604.	201	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	For example, suppose a surgeon would like a patient-specific osteotomy system 606 for an ankle fusion procedure. One goal of the ankle fusion procedure may be to relieve pain of the patient and to remove a minimal amount of bone in the process of completing the procedure. In such an example, the bone model 404 may be of one or more bones of a foot and/or ankle of the patient. The surgeon may provide a request and/or a set of user instructions 604 for a patient-specific osteotomy system 606 for this ankle fusion procedure.	202	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Those of skill in the art will appreciate that the user instructions 604 may be of a variety of different types, lengths, number of details and may be provided in a variety of different formats including oral, written, or the like. In one embodiment, the user instructions 604 may be a request for a patient-specific osteotomy system 606 that includes a set of default instruments, preoperative plan, implants, or the like. For example, the user instructions 604 may as short and simple as “Please provide an osteotomy system for an ankle fusion of the left ankle for patient <<identifying information (e.g., name, dob, etc.)>> with an anterior approach.” The user instructions 604 may be provided in the form of a product order, a purchase order, a prescription, or the like. The user instructions 604 may be provided in written manual / analog form, include a manual signature, digital form, include an e-signature, or the like. In addition, the user instructions 604 may include security and/or authorization features that enable the receiver to confirm that the user instructions 604 are valid and are authorized by a particular surgeon or doctor. The user instructions 604 may indicate the approach to the surgical site (e.g., an ankle or foot joint or bone) the surgeon wants to take, anterior, posterior, medial, lateral, or the like.	203	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In another embodiment, the user instructions 604 may include specific instructions for the number and/or kind or type of components in the patient-specific osteotomy system 606 and/or the configuration of one or more of these components. For example, the user instructions 604 may identify a specific fixation product or fixation system the surgeon will be using for permanent fixation of the osteotom(ies). Alternatively, or in addition, the user instructions 604 may include designation of one or more complementary components and/or configurations for these components to be included in the patient-specific osteotomy system 606.	204	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In one embodiment, the user instructions 604 may designate a particular material and/or mass for fabricating one or more guides to be included in the patient-specific osteotomy system 606. Some surgeons may find that patient-specific instruments, such as a patient-specific resection guide may more readily register to one or more bone surfaces if the instrument has a greater mass and/or weight. With the greater mass and a sufficient fidelity bone engagement surface, a patient-specific instrument may seem to find its own way or seek out a desired position on a bone that matches or substantially matches a position planned when the patient-specific osteotomy system 606 was developed. Consequently, a surgeon may request in the user instructions 604 that the instrument be made from a metal such as titanium.	205	Added by DJM Jan 2024	1/6/24, 10:01 PM

Page 9 of 23, showing 20 record(s) out of 459 total