Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-32	Advantageously, the present disclosure provides a system 900, 1000 for remediating a condition present in a patient. In the examples disclosed, the system 900,1000 can be used for forming closing wedges in a distal end of the leg near the ankle. Advantageously, the system 900,1000 includes both resection guides 920, 1020 and complementary components 930. Depending on the needs of a patient, one or more components of the system 900,1000 may be unique for the procedure on this patient. Consequently, the composition of the components in the complementary components 930 can vary from patient to patient.	255	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	In at least one embodiment, the complementary components 930 can include a trajectory guide, a guard, and one or more reduction guides 960, 1660a. In addition, the configuration and type of complementary components 930 can vary as well as the surgical technique in order to perform a surgical procedure for a particular patient. This may be due, at least in part, to challenges presented by certain components of the system 900,1000 (including complementary components 930, trajectory guides, guards, stops, and the like) and/or steps in the surgical technique.	256	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	FIG. 16E-16H illustrate examples of complementary components 930 for the system 1600 to address and/or remediate certain challenges. In one example embodiment, the system 1600 can include a resection guide 1020b having a proximal bone attachment feature 1058 that includes a first fastener 1602 that fits within a first hole 1604 and a second fastener 1606 that fits within a second hole 1608 (not shown in FIG. 16E) of the proximal bone attachment feature 1058. The resection guide 1020b includes a distal bone attachment feature 1060 that includes a third fastener 1610 that fits within a third hole 1612 of the distal bone attachment feature 1060.	257	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	Advantageously, the system 1600 includes resection guide 1020b that includes proximal bone attachment feature 1058 and distal bone attachment feature 1060 and resection feature 1022a and resection feature 1022b. Alternatively, or in addition, the system 1600 also includes one or more of a trajectory guide 1614 and/or a guard 1616.	258	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	A trajectory guide 1614 assists a surgeon by indicating what trajectory a cutting tool will take when used together with one or more resection features 1022 of the resection guide 1020. Said another way, the trajectory guide 1614 indicates a path for a resection that uses at least one of the resection features 1022.	259	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	In the illustrated embodiment, the third fastener 1610 serves as a trajectory guide 1614 and indicates that resection within the resection feature 1022b will result in a resection that travels medial to lateral starting plantar and advancing dorsally. Advantageously, the third fastener 1610 can be made of a radio-opaque material such as metal such that once the third fastener 1610 is deployed, a surgeon can take an x-ray or flouroscopy image of the ankle and visually see the trajectory the planned resection will take. By visually confirming the trajectory for a planned resection a surgeon can be assured that the surgical procedure is proceeding as expected.	260	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	The guard 1616, or stop, is an apparatus, device, or structure that serves to assist a surgeon by preventing resection of parts of tissue where resection is unplanned or undesired. Said another way, the guard prevents resection by a cutting tool beyond a boundary.	261	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	Advantageously, the third fastener 1610 can serve as a guard 1616. The third fastener 1610 can be made of a rigid and hard material such as metal that cannot be cut, or is not readily cut, by a surgical cutting tool. Once the third fastener 1610 is deployed, the third fastener 1610 serves as a guard 1616 or cutting boundary to prevent resection of a first bone through, or beyond, the position of the third fastener 1610. In the illustrated embodiment, the cutting tool may be a reciprocating saw blade that is wider than the third fastener 1610 such that the third fastener 1610 serves as an effective guard 1616.	262	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	Advantageously, the third fastener 1610 can serve as a fastener for the distal bone attachment feature 1060, as a trajectory guide 1614, and as a guard 1616. The features and advantages of using the system 1600 with the distal bone attachment feature 1060, trajectory guide 1614, and/or guard 1616 can greatly reduce stress or pressure a surgeon may experience in performing the surgical procedure. In addition, the distal bone attachment feature 1060, trajectory guide 1614, and/or guard 1616 can facilitate smooth and efficient and prompt execution of the surgical procedure and may improve outcomes from the surgical procedure.	263	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	FIG. 16E illustrates a potential obstacle to removing the resection guide 1020b once the resections are completed. Note that first fastener 1602 and second fastener 1606 extend perpendicular to a long axis of the tibia 224 and are parallel to each other. However, the third fastener 1610 extends at an angle relative to the long axis of the tibia 224 which prevents sliding the resection guide 1020b off without removing one or more of the fasteners.	264	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	FIG. 16F illustrates one way to remove the resection guide 1020b and utilize one or more reduction guides to assist a surgeon in performing an effective and successful reduction. FIG. 16F illustrates that the third fastener 1610 of the distal bone attachment feature 1060 can be and has been removed by the surgeon. Advantageously, the third fastener 1610 was deployed such that once removed, the third fastener 1610 leaves a passage 1618 in a distal bone fragment 224a. The first fastener 1602 and second fastener 1606 can remain in place.	265	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	With the third fastener 1610 removed, the resection guide 1020b can be slid off of the first fastener 1602 and second fastener 1606, as illustrated in FIG. 16F. Next, to facilitate reduction, a surgeon may reinsert the third fastener 1610 into the passage 1618, the same location the third fastener 1610 was originally deployed in. Now, the surgeon has the third fastener 1610 that can be used to position and reorient the distal bone fragment 224a and the first fastener 1602 and second fastener 1606 that can be used to position and reorient the proximal bone fragment 224b. In certain embodiments, the resection guide 1020b and/or a preoperative plan that includes proposed cutting depths within each of the resection features 1022 can be configured to leave a portion of bone 1620 in place, a living hinge, that can also facilitate manipulation and orientation of the bone fragments for the reduction.	266	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	Having stable and reliable access and control of the distal bone fragment 224a and proximal bone fragment 224b can provide important peace of mind for a surgeon prior to and during the surgical procedure. With the first fastener 1602, second fastener 1606, and third fastener 1610 in place within the bone fragments, a surgeon can proceed with the reduction. The system 1600 may include a reduction guide 1660b. The reduction guide 1660b is configured to guide reduction of one or more bone fragments to a reduced condition. In the illustrated embodiment, the reduction guide 1660b guides reduction of the distal bone fragment 224a and the proximal bone fragment 224b.	267	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	In the illustrated embodiment, the reduction guide 1660b includes a reduction anchor 1630 and a reduction stabilizer 1650. The reduction anchor 1630 and reduction stabilizer 1650 may cooperate to provide a stable and completed reduction of the distal bone fragment 224a and proximal bone fragment 224b.	268	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	The reduction anchor 1630 serves to engage one or more fasteners of a first bone fragment, such as proximal bone fragment 224b. In the illustrated embodiment, the reduction anchor 1630 includes a first hole 1632 and a second hole 1634 each configured to engage the first fastener 1602 and the second fastener 1606. The reduction anchor 1630 may also include an open end slot 1636 configured to receive the third fastener 1610.	269	Added by DJM Jan 2024	1/6/24, 9:49 PM
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

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