Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	TMC-PAT-4	Those of skill in the art will appreciate that, in one embodiment, anatomical data about the patient can be used to define other structures of the system (e.g., system 700 or system 800) or other patient specific instruments. For example, anatomical data about the patient that can be captured in the patient imaging data (e.g., due to the fidelity of the technology providing the patient imaging data) can be used to define how deep one or more resection features are. Controlling the depth of the resection features can be used to manage how deep a surgeon’s cutting instruments can reach within the resection features. Managing a depth for one or more resection features may be referred to as defining a patient specific height for a resection guide.	430	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	For example, in one embodiment, patient imaging data can be used to define a distance between at a top edge (e.g., superior side 914) of a resection guide (e.g., resection guide 820a, resection guide 820b, resection guide 820c) and a first surface (e.g., a surface of a first bone such as a medial cuneiform) or a bottom edge (e.g., an inferior side 916). Managing the distance between a top edge and a bone surface or bottom edge is one way to provide a stop within the resection guide. The stop can serve to limit how deep a surgeon will resect hard tissue/soft tissue when using the resection guide for a procedure. If a surgeon resects until the resection instruments engages the stop, the surgeon can be assured that the resection extends to a desired depth (not too far and not too short).	431	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	When a surgeon prepares to do an osteotomy, they take care to prepare for the surgical procedure by gathering as much information as possible about the patient’s anatomy, the surgical procedure, the instrumentation that will be used, and/or any implants to be used such that the goals of the surgical procedure can be realized. This preparation helps because once an osteotomy is performed changing or remediating the impact of the osteotomy can be challenging and can require time for bones to heal and recover. Thus, a surgeon seeks to perform osteotomies that are specific to the desired locations, with the desired trajectories, and to a desired depth. The goal of the osteotomies is to provide a correction and/or relief for a patient.	313	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	To facilitate a successful surgical procedure, surgeons appreciate guidance and advanced indications of signs as to where an osteotomy will be made and/or how the osteotomy will extend into the bone and/or tissue of the patient and how a reduction after the osteotomy will do in providing for the desired outcome. One sign or indicator that surgeons appreciate is a trajectory marker that is in one or more bones of the patient and indicates the trajectory the osteotomy will take. Advantageously, the present disclosure can provide such indicators (e.g., trajectory markers) by way of the bone attachment features 908, 910.	314	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one example embodiment, the bone attachment features 908, 910 are configured to enable fasteners 710 used with the bone attachment features 908, 910 to extend into one or more bones of the patient. Specifically, the holes 940 are configured such that fasteners deployed into the bone attachment features 908, 910 will show a surgeon the trajectory an osteotomy formed using the resection features 902, 904. In certain embodiments, this can be accomplished because one or more holes 940 of a bone attachment feature (e.g., first bone attachment feature 908 and/or second bone attachment feature 910) may extend through the body 900 to guide the fasteners 710 along a trajectory that is parallel to a trajectory of the resection feature (e.g., proximal resection feature 902 and/or distal resection feature 904) for the osteotomy that the cutting tool will cut. Of course, this parallel relationship can be implemented in one or more of the bone attachment features 908, 910 of the resection guide 820.	315	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, a surgeon can leverage this feature prior to making any cuts, forming any osteotomies. For example, a surgeon can secure the resection guide 820b to one or more bones of the patient on a dorsal or dorsomedial or medial side of the midfoot. The fasteners 710 cooperating with the bone attachment features 908, 910 can extend into the middle, and/or through to an opposite side of the midfoot. Since the fasteners 710 are often made of metal, the surgeon can then use fluoroscopy to visually see, validate, and/or check the trajectory for each fastener 710 into the midfoot. The surgeon knows that an adjacent and parallel osteotomy formed using the resection features 902, 904 will track (i.e., run parallel to) with the trajectories of the fasteners 710 in the bone attachment features 908, 910. In this manner, a surgeon can confirm trajectories for the planned osteotomies before the actually making the osteotomies. If the surgeon is not satisfied with the trajectories indicated by the bone attachment features 908, 910 by way of the deployed fasteners 710 within one or more bones a surgeon can make an adjustment. Removing the fasteners 710 if they are in an undesired location and/or trajectory can have a minimal impact on the patient and/or the success of the procedure.	316	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In the illustrated embodiment, the resection guide 820b may include one or more anchor features 942 (an anchor feature 942 can also be referred to as an auxiliary bone attachment feature). The anchor feature 942 can be an optional feature for a resection guide 820b or may be a required feature. The anchor feature 942 can serve a variety of purposes. For example, an anchor feature 942 can serve to engage with one or more bones or bone fragments that are to be resected from the patient. For example, a surgeon may position the resection guide 820b, secure the resection guide 820b to one or more bones using the bone attachment features 908, 910. Next, a surgeon may deploy a pin or K-wire in an opening of the anchor feature 942 to engage with one or more bone fragments (e.g., a wedge) that will be resected when the surgeon resects using the resection features 902, 904. After the resection, the resection guide 820b can be removed while a pin of the anchor feature 942 remains in place. That pin can then be used to manipulate, reposition, and/or remove a resected bone fragment.	317	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Alternatively, or in addition, an anchor feature 942 can be included to provide additional engagement with one or more bones of the patient during the osteotomies. The anchor feature 942 can be connected to the body 900. The anchor feature 942 can include one or more openings configured to receive one or more fasteners 710. The one or more fasteners 710 engage one or more bones of the patient.	318	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The anchor feature(s) 942 can be strategically positioned using the bone model 404 (and/or a model of a resection guide 820b) such that a fastener 710 in an opening of an anchor feature 942 engages higher quality and/or stronger bone than the bone beneath one or more other openings in other bone attachment features 908, 910. Advantageously, a position for an anchor feature 942 can be determined by a surgeon (e.g., a user) of the resection guide 820b. In this manner, the resection guide 820b can be further customized to the needs or preferences of a particular patient and/or surgeon.	319	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, the anchor feature 942 may be referred to as an oblique hole or an oblique feature. For example, where the first bone attachment feature 908 and/or second bone attachment feature 910 are angled to deploy a fastener 710 into a bone with a trajectory that is parallel to a trajectory for a resection directed by a proximal resection feature 902 and/or distal resection feature 904, the fasteners 710 in the first bone attachment feature 908 and/or second bone attachment feature 910 may not provide a desired level of engagement to retain the resection guide 820b in place during the forming of the osteotomies. Accordingly, a strategically placed anchor feature 942 can be angled (e.g., an oblique angle) relative to one or more bones of the patient such that a fastener 710 in the anchor feature 942 prevents or mitigates movement of the resection guide 820b during a surgical procedure. In one embodiment, the anchor feature 942 is configured to guide a third fastener 710 into a bone at an angle that is not parallel to one or more of the angles of a first fastener 710 deployed in a first bone attachment feature 908 and/or a second fastener 710 deployed in a second bone attachment feature 910.	320	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 9C illustrates an inferior view of an example resection guide 820b. Referring now to FIGs. 9C, 9D (distal side view), 9E (proximal side view), 9F (lateral side view), and 9G (medial side view), the resection guide 820b includes at least one patient-specific bone engagement feature. A patient-specific bone engagement feature serves to engage with one or more bones and/or other tissue of a patient to position or identify a position of a resection guide relative to the one or more bones. In one embodiment, the position of a resection guide relative to the one or more bones satisfies and/or matches a predetermined position defined using the models (e.g., bone model 404 and/or preliminary model of the resection guide). In certain embodiments, a patient-specific bone engagement feature is one example of a reference feature that can assist a user (e.g., surgeon).	321	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 9C illustrates one example of a patient-specific bone engagement feature 912. The patient-specific bone engagement feature 912 is configured to engage at least a portion of one or more bones of a patient during a surgical procedure. The patient-specific bone engagement feature 912 engages the one or more bones and/or joints in a manner that positions the resection guide 820b in a predetermined position. Advantageously, the patient-specific bone engagement feature 912 includes features, structures, and/or aspects that can provide feedback to a user moving the resection guide 820b in relation to surfaces of one or more bones of the patient. These features, structures, and/or aspects of the patient-specific bone engagement feature 912 may cause the resection guide 820b to shift and tilt as a user moves the resection guide 820b to an approximate position on the bones. However, since the features, structures, and/or aspects are mirror images of the recesses, bumps, projections, and/or surface features of the one or more bones, the resection guide 820b will not sit stable and secure until the resection guide 820b locks/seats into place once the resection guide 820b is moved to the same (or substantially the same) position on, or relative to, the one or more bones as in a predetermined position. The patient-specific bone engagement feature 912 causes the resection guide 820b to lock and/or snap into place once the correct position that matches the predetermined position is located.	322	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Those of skill in the art will appreciate that a patient-specific bone engagement feature 912 can take a variety of forms and/or configurations and can include a single structure or a plurality of structures that together form the patient-specific bone engagement feature 912. The patient-specific bone engagement feature 912 can be a single surface (e.g., a bone engagement surface) that is contoured, a plurality of surfaces or portions or sections that are contoured to match a contour of a bone or tissue surface, a surface in cooperation with a body structure that accounts for rises or falls in a contour of the one or more bones. Alternatively, or in addition, a patient-specific bone engagement feature 912 can include a structure and/or arm or other structure that extends from the body 900 and supports a contoured bone engagement surface.	323	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In the example of FIG. 9C, the patient-specific bone engagement feature 912 can take the form of a bone engagement surface 944. The bone engagement surface 944 may include a portion, some, or all of a surface of one side of a resection guide 820b. In certain embodiments, a bone engagement surface 944 can include two or more sections 944a, 944b. Each section may be a bone engagement surface 944. Alternatively, or in addition, one section may be a bone engagement surface 944 and another section may be planar or not contoured to match or mirror a surface of one or more bones and/or other tissue of a patient.	324	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, the bone engagement surface 944 includes a patient-specific feature that is defined to interface with at least a portion of a surface that includes one or more bones of a patient. The patient-specific feature can be a single feature or a plurality of features. These features may be structures that are configured and sized to fit into and/or engage with corresponding features of a surface. For example, one feature may be a protrusion, projection, extension, or the like sized and shaped to fit within a recess or opening or cavity in a surface of, or between, bones of a patient. Alternatively, a patient-specific feature can be an opening, recess, cavity, detent, or the like sized and shaped to accept a projection, extension or the like from a surface or other structure of, or between bones, of a patient.	325	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, an example patient-specific bone engagement feature 912 includes a bone engagement surface 944 that is one at least a portion of one side of the resection guide 820b. The bone engagement surface 944 includes one or more patient-specific features. In one embodiment, the feature is a contoured surface. In another embodiment, the feature may be a plurality of extensions and/or recesses that match, mate, and/or fit within corresponding extensions and/or recesses of a surface. The patient-specific feature is defined to interface with at least a portion of a surface that includes one or more bones of a patient. In the illustrated embodiment, the bone engagement surface 944 covers some of the inferior side 916 of the resection guide 820b. In another embodiment, the bone engagement surface 944 can cover all of the inferior side 916.	326	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, the bone engagement surface 944 is on a bone facing and/or bone contacting side of a resection guide 820b. In certain embodiments, the bone engagement surface 944 can extend across at least sixty-percent of a surface area of a side of the resection guide 820b. In another embodiment, can extend across at least ninety-percent of a surface area of a side of the resection guide 820b. In another embodiment, can extend across one hundred percent of a surface area of a side of the resection guide 820b. In another embodiment, can extend across at least twenty-percent of a surface area of a side of the resection guide 820b.	327	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Referring to FIG. 9E, in certain embodiments, the patient-specific bone engagement feature (e.g., a bone engagement surface 944) is coupled to an inferior side 916 of the body 900. Alternatively, or in addition, the body 900 can extend from a medial side M of a foot bone over a dorsal side D of the foot bone to a lateral side L of the foot bone. In this manner, the patient-specific bone engagement feature can contact at least three points on the foot bone. These three contact points can provide a stable and secure placement of the resection guide 820b. In certain embodiments, the patient-specific bone engagement feature (e.g., a bone engagement surface 944) is configured to engage at least a portion of a cuneiform and at least a portion of a metatarsal of a patient when the resection guide 820b is used. The patient-specific bone engagement feature, such as a bone engagement surface 944 and/or a landmark registration feature 960 (discussed below), can include a contour that is at least partially determined based on a bone model of a patient’s foot. The bone model may be defined based on medical imaging of the patient’s foot.	328	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIGs 9A, 9D, 9E, 9F, and 9G illustrate a landmark registration feature 960. The landmark registration feature 960 serves to facilitate registration of a guide 820b. In one embodiment, the landmark registration feature 960 is configured to contact and/or engage with a surface of one or more bones. In another embodiment, the landmark registration feature 960 is configured to contact and/or engage with one or more landmarks of one or more bones or other tissues of a patient. In another embodiment, the landmark registration feature 960 is configured to contact and/or engage with a joint and/or parts of a joint, such as a TMT joint, of a patient. For example, in one embodiment, the landmark registration feature 960 is configured to fit between articular surfaces of a cuneiform and a metatarsal of a TMT joint.	329	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The resection guide 820b can include one or a plurality of landmark registration features 960. In the illustrated embodiment, the resection guide 820b includes a landmark registration feature 960 that may also be referred to as a “joint seeker” or “seeker”. Given the shape of the example landmark registration feature 960, the landmark registration feature 960 may also be referred to as a blade.	330	Added by DJM Jan 2024	1/3/24, 4:24 AM

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