Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-23	For example, the osteotomy (e.g., first osteotomy) formed using the proximal resection feature 1112 may extend through the midfoot from the medial side to the lateral side. Similarly, the osteotomy (e.g., second osteotomy) formed using the distal resection feature 1114 may extend through the midfoot from the medial side to the lateral side. Thus, after the first osteotomy and second osteotomy are formed the bone wedge or wedge osteotomy can include a plurality of bone fragments between the first osteotomy and the second osteotomy and between the medial side of the midfoot and the lateral side of the midfoot.	351	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	The bone fragment(s) of the wedge osteotomy can be removed to perform for example, a midfoot closing wedge osteotomy. A surgeon may then continue to a surgical procedure to deploy an implant (e.g., a beam), 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.	352	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 the exemplary system may include a resection guide designed for a particular patient and their specific bone condition. For example, event of significant loss of bone or the lack of bone with a desirable level of density and/or structural integrity, the fasteners, resection guides, and/or complementary components can be strategically designed and placed on a patient’s foot to remove pathological bone and also be used to strategically place bone void fillers such allograft, 3D printed constructs (metallic, synthetic bone or biological), and the like. In this manner, a very patient-specific solution can be realized that may involve aspects of various surgical procedures but can be done with high precision and accuracy because the patient-specific instrumentation has been developed, designed, manufactured beforehand and is used to facilitate that realization of the planned correction during the procedure.	353	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 720 can be different. For example, suppose midfoot bones of a patient have deteriorated such that a larger wedge is to be resected than wedge in the example shown in FIG. 11. In such an embodiment, the body 732 of the resection guide 720 may be longer such that the distal resection feature 1114 is positioned near the base of the first metatarsal 208 and the proximal resection feature 1112 is positioned on, or near, a distal surface of the navicular 218. Also, as described in relation to the embodiments of FIG. 8, the wedge resected may open dorsally rather than plantar as in the example of FIG. 11.	354	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIG. 12 illustrates an exemplary system 1200, according to one embodiment. The system 1200 may include one or more fasteners 810, such as fasteners 710, a resection guide 820, such as resection guide 1220, and may include one or more other complementary components 730. In one embodiment, the resection guide 1220 is one example of a lateral resection guide.	355	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIGS. 13A-13D illustrate views of resection guide 1220. The resection guide 1220 may have many structures, features, and functions, operations, and/or configuration similar or identical to those of the resection features 722 described in relation to FIGS. 7-12, like parts are identified with the same reference numerals. Accordingly, the resection guide 1220 may include one or more resection features 722, bone attachment features 724, bone engagement surfaces 726, landmark registration features 728. The resection guide 1220 may include a body 732, connector 733, anterior side 734, posterior side 736, plantar side 738, dorsal side 742, medial side 744, and/or lateral side 746. And, as with the resection features 722, embodiments of the resection guide 1220 may include an auxiliary bone attachment feature 752, connector 754, resection window 756, first bone attachment feature 766, and/or second bone attachment feature 768. As with the resection features 722 of other embodiments of resection guide 720, the resection features 722a,b can include an open end 729 and a closed end 731.	356	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In the illustrated embodiment, the resection features 722 are closer together at the closed ends 731 and further apart at the open ends 730. In other words, the wedge shape opens dorsally. Of course, other embodiments of the resection guide 1220 can include resection features 722 that open plantarly.	357	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In the illustrated embodiments, the resection guide 1220 includes two resection features 722. In other embodiments, the resection guide 1220 may include one resection feature 722, three resection features 722, four resection features 722, or the like.	358	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In the illustrated embodiment, the resection guide 1220 may be configured for use on a lateral side of a midfoot of a patient, with the side visible in FIG. 12 facing away from the bone(s). The resection features 722a,b may be positioned and oriented relative to each other to facilitate forming cuts for a wedge that can be resected to form a closing wedge. Of course, the open ends 730 and closed ends 731 of two resection features 722 of the resection guide 1220 may also be on opposites sides of the resection guide 1220.	359	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Advantageously, the angle of each resection feature 722 relative to each other and relative to one or more bones (or bone surfaces or other reference points, reference lines, and/or reference planes) can be determined, selected, or indicated by a surgeon before the resection guide 1220 is fabricated. Similarly, a surgeon can designate whether they want a resection guide 1220 for forming a plantar opening wedge or a dorsal opening wedge. In addition, a surgeon can designate which sides of the resection features 722 are open end 729 or closed end 731 which can result in an embodiment such as resection guide 1220. In the illustrated embodiment, the proximal resection feature 758 includes a closed plantar end 731 and an open dorsal end 729 and the distal resection feature 762 includes a closed plantar end 731 and an open dorsal end 729.	360	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	The resection features 722a,b guide a surgeon in performing a resection by facilitating keeping a cutting tool in line with and/or within an opening of the resection features 722a,b (at a desired trajectory relative to one or more bones of the patient). In the illustrated embodiments, the resection features 722 are shaped like slots or channels and include an open end 729 and a closed end 731. One difference between the illustrated embodiments of the resection guides 720a,b,c may be the relationship of the open end 729 and closed end 731 of one resection feature 722 in relation to another resection feature 722 of the same resection guide 720. Another difference may be a relationship of the open end 729 and closed end 731 of one resection feature 722 in relation to another resection guide 720a,b,c.	253	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In the illustrated embodiment, each of the resection guides 720a,b,c may be configured for use on a medial side of a midfoot of a patient, with the side visible in FIG. 7 facing away from the bone(s). The resection features 722a,b may be positioned and oriented relative to each other to facilitate forming cuts for a wedge that can be resected to form a closing wedge. One resection guide 720 (e.g., resection guide 720a) may be configured to facilitate forming a wedge resection (e.g., bone wedge) that opens towards a plantar side of the midfoot. Another resection guide 720 (e.g., resection guide 720b) may be configured to facilitate forming a wedge resection (e.g., bone wedge) that opens to a dorsal side of the midfoot. Both resection guide 720a and resection guide 720b include resection features 722a,b with the open ends 730 and closed ends 731 on same side. Of course, the open ends 730 and closed ends 731 of resection guide 720b or resection guide 720a can also be on opposite sides of each other (like resection guide 720c). Another resection guide 720 (e.g., resection guide 720c) may be configured to facilitate forming a wedge resection that opens to a plantar side of the midfoot. The open ends 730 and closed ends 731 of resection guide 720c are on opposites sides in the resection guide 720c.	254	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 the resection guide 720 may have a variety of shapes, sizes and configurations. In one embodiment, these attributes can each be customized and adapted to meet needs or preferences of patients, a patient’s anatomy, the nature of the deformity, and/or surgeon preferences. Advantageously, the features of the resection guides 720 can facilitate one or more osteotomies as well as other steps in a surgical procedure.	255	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	Advantageously, the angle of each resection feature 722 relative to each other and relative to one or more bones (or bone surfaces or other reference points, reference lines, and/or reference planes) can be determined, selected, or indicated by a surgeon before the resection guide 720 is fabricated. Similarly, a surgeon can designate whether they want a resection guide 720 for forming a plantar opening wedge or a dorsal opening wedge. In addition, a surgeon can designate which sides of the resection features 722 are open end 729 or closed end 731 which can result in an embodiment such as resection guide 720a, resection guide 720b, or resection guide 720c.	256	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIG. 9A illustrates an example resection guide 720. The example resection guide 720 includes a proximal resection feature 758 connected to the body 732 having an open end 729 that is open at the plantar side 738 (e.g., an open plantar end) and a closed end 731 that is closed at the dorsal side 742 (e.g., a closed dorsal end). The example resection guide 720 includes a distal resection feature 762 connected to the body 732 having an open end 729 that is also open at the plantar side 738 (e.g., an open plantar end) and a closed end 731 that is also closed at the dorsal side 742 (e.g., a closed dorsal end). In certain embodiments and/or for certain surgeons having two ends of the resection features 722 may facilitate forming a first osteotomy and a second osteotomy using the resection features 722. For example, a surgeon may insert a cutting tool having a common orientation and/or position for both resection features 722 and make a similar cutting motion to form the osteotomies in each resection features 722. This can simplify the osteotomy procedures for the surgeon and/or assistants during the surgical procedure.	257	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIGS. 9A-9D illustrate views of an example resection guide 720a of the system 800 of FIG. 8, according to one embodiment. The resection guide 720a 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 720 may include one or more landmark registration features 728. Other embodiments may not include landmark registration features 728. The resection guide 720a 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. The resection guide 720a 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. In one embodiment, the resection guide 720a is configured for use on a medial side of a midfoot of a patient. Thus, the resection guide 720a can be referred to as a medial resection guide. The names of the sides of the resection guide 720a refer to the position of the sides when the resection guide 720a is in use on one or more bones of the midfoot.	258	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	FIG. 9A is an inferior perspective view. FIG. 9B is a superior perspective view. FIG. 9C is lateral side perspective view. FIG. 9D is a posterior side perspective view.	259	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	The body 732 may include resection features 722 that guide a cutting tool to resect one or more bones, such as a medial cuneiform and/or a first metatarsal in the manner needed to make the desired resection. For example, the resection features 722 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 722 may guide a reciprocating planar blade, such as that of a surgical bone saw, that forms planar cuts in a first cuneiform and a first metatarsal. Various manual or powered tools may be used to form the planar cuts. In one embodiment, a sagittal bone saw can be used.	260	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In one embodiment, the proximal resection feature 758 guides a cutting tool to form a first osteotomy in one or more bones of a patient. Similarly, the distal resection feature 762 is used to form a second osteotomy in one or more bones of the patient. Advantageously, the first osteotomy and the second osteotomy can be configured to resect a desired amount, size, and/or shape of bone or bones and/or soft tissue from a midfoot of the patient.	261	Added by DJM Jan 2024	1/6/24, 9:56 PM
View Edit Delete	PER-23	In one example, the resection features 722 may take the form of a proximal resection feature 758 and a distal resection feature 762. In one embodiment, the proximal resection feature 758 and the distal resection feature 762 extend from the medial side 744 to the lateral side 746. For example, the proximal resection feature 758 may extend through the body 732 of the resection guide 720a from the medial side 744 to the lateral side 746 along a first trajectory 902. Similarly, the proximal resection feature 758 may extend through the body 732 of the resection guide 720a from the medial side 744 to the lateral side 746 along a second trajectory 904.	262	Added by DJM Jan 2024	1/6/24, 9:56 PM

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