Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-33	"Positioner" or "positioning guide" refers to any structure, apparatus, surface, device, system, feature, or aspect configured to position, move, translate, manipulate, or arrange one object in relation to another. In certain embodiments, a positioner can be used for one step in surgical procedure to position, arrange, orient, and/or reduce one bone or bone fragment relative to another. In such embodiments, the positioner may be referred to as a bone positioner. In certain embodiments, the term positioner or positioning guide may be preceded by an adjective that identifies the structure, implement, component, or instrument that may be used with, positioned by, and/or guided by with the positioner. For example, a “pin positioner” may be configured to accept a pin or wire such as a K-wire and serve to position or place the pin relative to another structure such as a bone.	69	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	"Rotation guide" or "rotator" refers to any structure, apparatus, surface, device, system, feature, or aspect configured, designed, engineered, or fabricated to rotate or aid a user in the rotation of one structure relative to another structure. In certain embodiments, a rotation guide or rotator may be used to help a surgeon rotate one or more bones, parts of bones, bone fragment, an implant, or other anatomical structure, either alone or in relation to another one or more bones, parts of bones, bone fragments, implants, or other anatomical structures.	70	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	"Trajectory" refers to a path a body travels or a path configured for a body to travel through space. (Search "trajectory" on wordhippo.com. WordHippo, 2023. Web. Modified. Accessed 13 June 2023.)	71	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	"Trajectory guide" or "trajectory indicator" or "targeting guide" refers to any structure, apparatus, surface, device, system, feature, or aspect configured to indicate, identify, guide, place, position, or otherwise assist in marking or deploying a fastener or other structure along a desired trajectory for one or more subsequent steps in a procedure.	72	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	"Trajectory port" refers to any structure, apparatus, surface, device, system, feature, or aspect configured to indicate, identify, guide, place, position, or otherwise assist in marking or deploying a fastener, an anchor, a tunnel, an opening, or other structure along a desired trajectory for one or more subsequent steps in a procedure. In certain embodiments, a trajectory port includes a body or base (aka a port body) and an opening or port. The base/body supports the opening and the opening extends through the base/body from one side to the opposite side and has a predetermined angle of incidence with a hard tissue or a soft tissue of a patient.	73	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	"Tendon trajectory guide" refers to a trajectory guide configured to indicate, identify, guide, place, position, or otherwise assist in deploying a tendon or other soft tissue along a desired trajectory for one or more subsequent steps in a procedure.	74	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-23	FIGS. 13A-13D illustrate views of an example resection guide 1220 of the system 1200 of FIG. 12, according to one embodiment. The resection guide 1220 includes one or more resection features 722, one or more bone attachment features 724, and/or one or more bone engagement surfaces 726. In certain embodiments, the resection guide 1220 may include one or more landmark registration features 728. Other embodiments may not include landmark registration features 728. The resection guide 1220 includes a body 732 that connects one or more resection features 722, one or more bone attachment features 724, and/or one or more bone engagement surfaces 726.	361	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In the illustrated embodiment, the posterior side 736 includes a first bone attachment feature 766 and the anterior side 734 includes a second bone attachment feature 768. In one embodiment, the holes 764 of the first bone attachment feature 766 are aligned (along a longitudinal axis of the body 732) with the second bone attachment feature 768. Alternatively, or in addition, the first bone attachment feature 766 and second bone attachment feature 768 are not aligned with each other.	362	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	The resection guide 1220 includes an anterior side 734, a posterior side 736, a plantar side 738, a dorsal side 742, a medial side 744, and a lateral side 746. FIG. 13A is a lateral perspective view. FIG. 13B is a dorsal perspective view. FIG. 13C is medial side perspective view. FIG. 13D is an anterior side perspective view.	363	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In the illustrated embodiment, one landmark registration feature 728 may extend from the medial side 744 or the first bone attachment feature 766. Advantageously, the landmark registration feature 728 can provide a surgeon with confidence and assurance in the placement and positioning of the resection guide 1220 on a bone because the landmark registration feature 728 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 728 can include a contoured bone engagement surface that can further facilitate registration of the landmark registration feature 728 and/or resection guide 1220 with the bone. In this manner, a surgeon can be assured intraoperatively that the resection guide 1220 is being positioned in accordance with a preoperative plan.	364	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In certain embodiments, the landmark registration feature 728 can be shaped like a hook to engage a surface of bone. Alternatively, or in addition, the resection guide 1220 may include a landmark registration feature 728 on different sides, together the landmark registration features 728 can engage one or more landmarks of a surface of the bone such that the surgeon can accurately position and register the resection guide 1220 to the bone.	365	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Conventional surgical procedures on the midfoot can be done to address a variety of pathologies and/or conditions of a patient’s anatomy. Furthermore, a variety of wedge resections, opening wedge, closing wedge, and the like can be performed to address varus, valgus, dorsiflexion, plantarflexion and other orientation conditions of the foot generally and/or particular bones of the foot. Advantageously, the patient-specific apparatus, methods, and systems of the present disclosure can be implemented based on patient imaging data to address these various conditions. In addition, the medical techniques that incorporate the patient-specific apparatus, methods, and systems of the present disclosure can include certain conventional steps and stages and new stages or steps that are enabled by the present disclosure.	366	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	For example, in certain medial midfoot and/or lateral midfoot surgical procedures a surgeon may prefer to deploy one or more fasteners at a predetermined angle or trajectory into one or more bones of the midfoot prior to making any resection. The surgeon may then use imaging techniques such as fluoroscopy to verify that the fasteners are in the desired position and have the desired trajectory and/or have a desired depth. If the imaging indicates the fasteners are in not a desired position with a desired orientation, a surgeon may re-deploy one or more fasteners and then re-check the position using medical imaging equipment.	367	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	If the imaging confirms the fasteners are in a desired position with a desired orientation, a surgeon may resect one or more bones by moving a cutting tool between and/or along the deployed fasteners. In this manner the fasteners may serve as a stop or guide to prevent resection beyond the position of the fasteners.	368	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Advantageously, the present disclosure can facilitate conventional surgical techniques by using the systems disclosed herein. As explained above, the bone attachment features 724 may be configured to facilitate using fasteners 710 deployed in holes 764 to serve the same purpose as the fasteners used in conventional midfoot surgical procedures. One way this can be accomplished is by having a trajectory for fasteners 710 in the bone attachment feature 724 extend parallel to a trajectory for one or the other or for each of the proximal resection feature 758 and the distal resection feature 762. Alternatively, or in addition, the holes 764 can be angled to have the same trajectory a surgeon desires for the resection of bone, such as a resection of a wedge. In this manner, the fasteners 710 in the holes 764 of the bone attachment features 724 can serve to guide a surgeon to ensure that they do not resect beyond the position of the fasteners 710. Advantageously, the embodiments of the resection guide 720 and/or the preoperative planning of the present disclosure can provide a surgeon with the confidence that resection using the resection features 722 will be as planned that costly intraoperative medical imaging can be avoided. This can save costs for the surgical procedures and time and minimize patient exposure to radiation emitted by the medical imaging equipment.	369	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIG. 14 illustrates a stage of performing a surgical procedure using a lateral approach to form a closing wedge. FIG. 14 illustrates a dorsal perspective view of a foot and ankle including a talus 222, a calcaneus 224, a tibia 226, and a navicular 218. Certain patients may present with midfoot bones having a variety of conditions. Due to age, disease, deformity, or different pathologies, the bones of the midfoot may be deteriorated to the point that individual bones may be challenging to distinguish from each other. FIG. 14 illustrates one such example. The division between the talus 222 and the navicular 218 may be challenging to distinguish. Also, the medial cuneiform 202, intermediate cuneiform 204, and/or lateral cuneiform 206 may be challenging to distinguish from each other.	370	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIG. 14 illustrates one example of a resection guide 1220 coupled to the bones using bone attachment features 724 that include fasteners 710, e.g., K-wires. In one embodiment, a surgeon has formed an incision down to the cortical bone surface with a lateral approach. In the illustrated embodiment, the resection guide 1220 may be configured (e.g., using the bone engagement surface 726) to seat near where the lateral cuneiform 206 contacts the navicular 218. The surgeon has deployed two or more fasteners 710 (e.g., K-wires) through the holes 764 of the bone attachment features 724. The surgeon has also resected the bones to remove a wedge shape that extends from the lateral side of the foot toward the medial side. Here, the two cuts may form two cut surfaces that form a wedge shape of bone that has been removed to perform a midfoot closing wedge osteotomy.	371	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIG. 14B is a close-up view of the same stage illustrated in FIG. 14A. A surgeon may then continue to a surgical procedure to deploy an implant and/or fuse the resected surfaces of the one or more bones. In certain procedures, such as those to address a charcot condition, the resections may extend from the medial side of the foot to the lateral side. Alternatively, or in addition, the resections may cross each other within the foot and form a wedge shape that can be used to address the condition.	372	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	With the resection completed, the resection guide 1220 can be removed and the fasteners 710 used to translate and/or rotate the proximal and distal bone or bone fragments of the midfoot. In one embodiment, a compressor or distractor can be deployed over the fasteners 710 to facilitate joining the cut surfaces and/or fusing the bones.	373	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Those of skill in the art will appreciate that for certain patients with certain pathologies, the form and/or shape of the resection guide 1220 can be different. For example, suppose midfoot bones of a patient have deteriorated such that a larger wedge is to be resected than the example shown in FIG. 14. In such an embodiment, the body 732 of the resection guide 1220 may be longer such that one resection feature is positioned near a distal end of the navicular 218 and another resection feature is positioned on, or near, a base of one or more metatarsals.	374	Added by DJM Jan 2024	1/6/24, 9:56 PM

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