Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	TMC-PAT-4	Referring still to FIG. 12, reduction of a first osteotomy of a cuneiform with a second osteotomy of a metatarsal closes the angle A from its initial number of degrees to zero degrees or substantially zero degrees and brings fourth trajectory 1110 into alignment and to be parallel to DP axis 1204. The metatarsal rotates within the frontal plane to provide a correction. Those of skill in the art will appreciate that alternative embodiments of the resection guide 820c may include a first bone attachment feature 908 and a second bone attachment feature 910 that deploys fasteners that are aligned along dorsal axis 1206 and longitudinal axis 1202. In such embodiments, a surgeon may manually rotate the metatarsal. Alternatively, or in addition, a compression block and/or reduction guide may include holes that are not aligned (e.g., proximal holes may not align with distal holes, which extend into the device at an angle similar to angle A) that receive the fasteners such that sliding of the compression block and/or reduction guide over the fasteners rotates the metatarsal.	410	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	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. 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.	411	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 13 illustrates a medial perspective view of a resection guide according to one embodiment. FIG. 13 illustrates the proximal resection feature 902, distal resection feature 904, window 906, first bone attachment feature 908, second bone attachment feature 910, and landmark registration feature 1004. In the illustrated embodiment, the landmark registration feature 1004 includes a medial surface 1006 that is contoured to match a lateral surface of a portion of a base of a metatarsal of the patient. Advantageously, the window 906 extends into the proximal resection feature 902 and the distal resection feature 904 such that a surgeon using the resection guide 820c can see (both visually and/or with the aid of fluoroscopy) the distal end of a cuneiform and a proximal end of a metatarsal of a TMT prior to making any cuts.	412	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The present disclosure includes a method of using the resection guide 820c and/or other components of the system 800. Initially, a surgeon may form an incision transverse to a tarsometatarsal (“TMT”) joint and/or a cuneonavicular joint with a dorsal approach. The resection guide 820c, in one example, may be configured (e.g., using one or more bone engagement features) to seat on and between a dorsal surface of both the medial cuneiform 202 and the first metatarsal 208. The surgeon forms the incision down to the cortical bone surface. The surgeon also cuts, or moves to the side, soft tissue covering the cortical bone surface of the bones sufficient to seat the bone engagement features to the cortical bone surface. In certain embodiments, this can include capturing and displacing the Extensor Hallucis Longus (EHL) tendon that may run along a lateral side of the TMT joint.	413	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Next, the surgeon positions the resection guide 820c on one or more bones so as to span the TMT joint and may extend into and/or cross a cuneonavicular joint. As described herein, the resection guide 820c is patient-specific and has been designed and/or fabricated specifically for this patient and/or for this surgical procedure.	414	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In addition, the body 900 of the resection guide 820c includes a bone engagement surface (not visible in FIG. 13). The bone engagement surface may span the inferior side 916 of the body 1110. Advantageously, the bone engagement surface includes a patient-specific surface that includes a contour that mirrors a contour of a plurality of bones. The patient-specific surface is defined at least in part using a bone model 404 of at least one bone of the patient’s foot. The bone engagement surface is on a bone-facing surface of the body 900 when the resection guide 820c is in use. The bone engagement surface assists a surgeon in positioning the resection guide 820c in the same or substantially the same position as predetermined using a model of the resection guide 820c and/or one or more models of one or more bones of the patient.	415	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The bone engagement surface 944 can extend across the entire inferior side 916 including features such as inferior sides of the first bone attachment feature 908 and/or second bone attachment feature 910, anchor feature 942 and the like. Alternatively, or in addition, the bone engagement surface 944 may extend over a smaller portion of the inferior side 916.	416	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	One goal of the bone engagement feature 912 is to accurately engage with and/or position a structure in relation to one or more bones, bone fragments, or parts of a bone such as one or more cortical surfaces of one or more bones. Advantageously, embodiments of the present disclosure can accurately position a patient-specific such as a resection guide 820c in relation to one or more bones, such as those of a TMT joint. In certain embodiments, a bone engagement feature 912 may be configured to accurately engage with the one or more bones or bone parts or bone surfaces using a minimal number of contact points and/or contact surfaces.	417	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	For example, referring to FIGS. 13, 10D and 10E, a bone engagement feature 912 can be configured to wrap around multiple surfaces of a bone. With such a configuration, the bone engagement feature 912 may not need to contact more than three or four parts of the bone in order to accurately register and orient a resection guide 820c with the bone. In FIGs 10D and 10E, a proximal and distal view of the distal side 920 and medial side 922 is illustrated. This view shows a concave area where a bone such as a metatarsal will be positioned, when the resection guide 820c is positioned before being secured to the bone(s). Advantageously, the body 900 and bone engagement feature 912 are configured to contact the bone (which has a medial, dorsal, and lateral cortex with an irregular semicircle and/or wedge shaped cross section) in about three areas (e.g., a medial cortex area M , a dorsal cortex area D, and a lateral cortex area L). In certain embodiments, contact with the bone in these three areas can be sufficient to register the resection guide 820c in the desired location relative to the bone. Of course, more contact areas can be employed to further facilitate placement and registration of the resection guide 820c relative to the bone.	418	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, four contact points may be used. Those of skill in the art will appreciate that with respect to the contact points for the bone engagement feature 912 structures other than a contoured surface can be used. For example, projections from the inferior side 916 can extend towards and contact the bone. Alternatively, or in addition, sections of the inferior side 916 can be recessed such that sections, portions, or areas of contoured sections can be formed that are contoured to mirror and match and/or mate with corresponding areas on a surface of a bone. The size, shape, surface contour, and configuration of these contoured sections can be patient-specific and can be defined using a bone model of a bone of a patient. These areas of contoured sections may resemble pads or feet that contact a surface or other structure of a bone.	419	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Returning to an example medical procedure that uses the resection guide (e.g., any of the embodiments of resection guides of the present disclosure), after a surgeon positions the resection guide 820c on a surface of one or more bones, a surgeon may next translate and/or rotate the resection guide 820c until the bone engagement feature 912 engages with one or more bones and/or bone structures (e.g., surfaces) and registers with the bone(s). For example, the bone engagement surface 944 may interlock with a cortical surface of one or more bones. Similarly, a landmark registration feature 1004 may engage with a bone structure, such as joint and/or a base of a metatarsal.	420	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	This registration can, in certain embodiments, be detected by a tactile change in how the resection guide 820c moves in relation to the bone. At one point, the resection guide 820c may move freely, but once registered, the resection guide 820c may “lock into place” and no longer readily move or translate in relation to the bone.	421	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	After the resection guide 820c “locks into place” a surgeon may deploy one or more fasteners into the first bone attachment feature 908 and/or the second bone attachment feature 910 to secure the resection guide 820c to one or more bones. A fastener deployed in the first bone attachment feature 908 can enter the medial cuneiform 202. A fastener deployed in the second bone attachment feature 910 can enter the first metatarsal 208. Additional fasteners may be deployed into the bones using the first bone attachment feature 908 and second bone attachment feature 910.	422	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	At this stage, a surgeon may use fluoroscopy to confirm that the trajectories of fasteners in the first bone attachment feature 908 and/or second bone attachment feature 910 have trajectories that correlate to desired trajectories that osteotomies formed using the proximal resection feature 902 and distal resection feature 904 will have. This is because the trajectory of the proximal resection feature 902 is parallel to the trajectory of the first bone attachment feature 908 and the trajectory of the distal resection feature 904 is parallel to the trajectory of the second bone attachment feature 910.	423	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, a surgeon may also deploy a fastener in an anchor feature 942 to provide further stability and engagement of the resection guide 820c with the one or more bones.	424	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Next, a surgeon can resect the first metatarsal 208 using the distal resection feature 904 and the medial cuneiform 202 using the proximal resection feature 902. After resection, the two cut surfaces may be prepared for fusion of the two bones by pressing the two cut surfaces against each other. Alternatively, or in addition, a surgeon may prepare the cut surfaces using a rasp or other instrument to facilitate a union of the bones.	425	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	With the resection(s) completed, the resection guide can be removed and one or more fasteners 710 retained in one or more bones. The retained fasteners may be used to translate and/or rotate the proximal and distal bone or bone fragments. In one embodiment, a compressor or distractor can be deployed over the fasteners 710 to facilitate joining, translating, holding, and/or positioning the cut surfaces and/or fusing the bones. Those of skill in the art will appreciate that for certain patients with certain pathologies, the form and/or shape of the resection guide can be different. As explained above, the resection guide can be positioned, sized, configured, and oriented and/or trajectories set for the resection guide preoperatively using bone models. Additionally, a surgeon can provide a prescription for the location of guide features (e.g., resection features) to account for other conditions of a particular patient. Those of skill in the art will appreciate that the resection guide can be used for a variety of procedures in a hindfoot, midfoot, forefoot, hand, wrist, elbow, shoulder, and/or the like. One skilled in the art can appreciate that the presented embodiments may be modified, revised, or repositioned to address a surgeon’s particular angles, approach, entry locations and/or preferences.	426	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Next, a surgeon may remove a fastener of the anchor feature 942 and/or one or more fasteners in the first bone attachment feature 908 and/or second bone attachment feature 910 and remove the resection guide 820c. All the fasteners may be removed, or select fasteners may be removed, such that the resection guide 820c can be removed and certain fasteners may remain in the bone(s). In certain embodiments, certain fasteners may be reinserted into the same holes used previously.	427	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Next, a surgeon may reduce the osteotomies and combine the two bones at the cut surfaces. This can be done manually, or a compressor and/or a compression block may engage one or more of the fasteners. As described herein, this reduction and/or compression translates one or more of the bones and/or can rotate one or more of the bones to provide a rotational correction for a deformity. After compression, a surgeon may secure the two bones together with either provisional or permanent fixation and may deploy one or more implants to hold the bones in place.	428	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, the apparatuses, systems, and methods of the present disclosure can be used to plan these osteotomies, determine the desired angles (in one, two, or three planes) for cuts for each wedge segment, a desired depth for the cuts, define suitable resection guides for the surgical procedure, manufacture suitable resection guides for the surgical procedure, and demonstrate how the anatomy will look or reduce once the osteotomies are completed, the bones are positioned, and the surgical procedure is completed.	429	Added by DJM Jan 2024	1/3/24, 4:24 AM

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