Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	TMC-PAT-4	FIG. 10B is a superior view of the resection guide 820c. FIG. 10B illustrates a first bone attachment feature 908 that extends from the proximal side 918 and a second bone attachment feature 910 that extends from the distal side 920. FIG. 10B also illustrates a landmark registration feature 1004 that extends from the distal side 920. In one embodiment, the landmark registration feature 1004 is distinct from the landmark registration feature 1004 of other embodiments. In another embodiment, the landmark registration feature 1004 may be similar to the landmark registration feature 1004 of other embodiments.	351	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 10B also illustrates bone attachment features 908, 910. Certain bone attachment features may be positioned to engage with a resected segment, wedge, or bone fragment and other bone attachment features may engage with remaining bones or bone segments after resection. Furthermore, the resection guide 820c may include bone attachment features that are strategically positioned in the resection guide 820c to serve as trajectory guides, attachment points, compression anchors, distraction anchors, reduction guides or the like. For example, bone attachment features 908, 910 and the pins or fasteners deployed in holes of the bone attachment features 908, 910 can be strategically placed in a way that following the osteotomies, the fasteners/pins can then be manipulated to aid in the reduction/correction of the osteotomies either manually and/or using specialized instrumentation and/or customized instrumentation or compression blocks.	352	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In addition, the bone attachment features and associated fasteners (e.g., pins) can be designed, positioned, oriented, and utilized to target provisional and/or permanent fixation devices such as pins, staples (using holes formed by the fasteners), screws, bolts, beams, nail or strategically placed reduction wires that can be utilized for external devices such as external fixators. Furthermore, customized guides can be placed over strategically placed fasteners used with bone attachment features and these fasteners can be used for the purposes of pre-drilling fixation components or features of implants such as for screws or strategic placement of fixation, plates, staples, etc.	353	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 10C is an inferior view of the resection guide 820c. FIG. 10B illustrates a bone engagement feature 912. The bone engagement feature 912, in this embodiment, includes a bone engagement surface 944b near the proximal end 824 and a bone engagement surface 944a near the distal end 826. FIG. 10B also illustrates that the size and shape of the body 900 have been configured to provide a sufficient size for the bone engagement surface 944a and/or bone engagement surface 944b for registration with one or more bones of a patient. However, the size and shape of the body 900 may be no larger than needed for accurate registration and strength of the guide and of a minimal size and shape.	354	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, the bone engagement feature 912 can include a plurality of sections such as bone engagement surface 944a and/or bone engagement surface 944b. In certain embodiments, each of these bone engagement surfaces together or separately can be specifically configured based on the patient anatomy, surface topography, and/or surgeon preferences to facilitate positioning and/or placement of the resection guide 820c. In one embodiment, one bone engagement surface can have a different level of detail and/or fidelity than others. In certain embodiments, parts of the inferior side 916 may include a depression, opening, and/or void that is sized to not contact the bone of a patient and instead provides clearance for desired positioning of the resection guide 820c. This can be helpful in reducing the complexity and/or fabrication costs for the resection guide 820c.	355	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 10C also illustrates details of the illustrated embodiment of the landmark registration feature 1004. In the illustrated embodiment, the landmark registration feature 1004 includes a medial surface 1006 and a lateral surface 1008. (See also FIGs. 10F and 10G). In one embodiment, the landmark registration feature 1004 may be configured to engage with a metatarsal of a patient. Specifically, the landmark registration feature 1004 may be configured to engage with a base of the metatarsal of a patient that is part of a TMT joint of a patient. Accordingly, the landmark registration feature 1004 may include a medial surface 1006 that is contoured to match a surface of at least a portion of a base of a metatarsal of the patient.	356	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, the medial surface 1006 is a bone engagement surface configured to engage a lateral surface of the base of the metatarsal. In certain embodiments, the bone engagement surface of the medial surface 1006 may be defined based at least in part on a model of a metatarsal of a specific patient. When the resection guide 820c is in use and positioned in a desired position, the medial surface 1006 with its bone engagement surface may contact and/or engage with at least a portion of a lateral surface of the base of a metatarsal of the TMT joint. In this manner, the landmark registration feature 1004 facilitates engagement and placement of the resection guide 820c in a predetermined position.	357	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, the landmark registration feature 1004 may be referred to as a lateral metatarsal tab, at least in part because the landmark registration feature 1004 is configured to engage with a lateral surface of a base of a metatarsal. In another embodiment, the landmark registration feature 1004 may include a plurality of planes for additional surfaces of the landmark registration feature 1004. These planes can be oriented in a variety of directions and can be configured to be patient-specific surfaces, patient-matched surfaces, or the like. Advantageously, a landmark registration feature 1004 having a plurality of surfaces can enable fabrication of instrumentation (e.g., resection guides) that are further tailored, configured, and/or designed to meet the needs of a particular patient and/or user.	358	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In the illustrated embodiment, the landmark registration feature 1004 extends from the distal side 920 of the body 900. The position along the distal side 920 and the length and/or configuration of the landmark registration feature 1004 can be patient-specific and can be determined at least in part based on a bone model of one or more bones of a patient. In certain embodiments, the landmark registration feature 1004 may be referred to as a “met base arm” because it extends from the body 900 like an appendage towards a metatarsal of a patient. Those of skill in the art will appreciate that the landmark registration feature 1004 may not include a bone engagement surface on the medial surface 1006. Similarly, the resection guide 820c can include a plurality of landmark registration features. In such an embodiment, one or more landmark registration features 1004 may extend toward and/or engage with a cuneiform or other bone of a patient and/or one or more landmark registration features 1004 may extend toward and/or engage with a metatarsal or other bone of a patient. Alternatively, or in addition, a user such as a surgeon may request that a landmark registration feature 1004 be included in the resection guide 820c or may request that a landmark registration feature 1004 be omitted. Or a user may request one or more landmark registration features 1004 configured to engage other parts of one or more bones of a patient.	359	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 10D is a distal side view of the resection guide 820c. FIG. 10D illustrates a profile view of a soft tissue displacement feature 1020. The soft tissue displacement feature 1020 moves and/or holds soft tissue in a displaced condition/state while the resection guide 820c is in use. In one embodiment, the soft tissue displacement feature 1020 engages soft tissue that is adjacent to one or more bones when the resection guide 820c is in use. Those of skill in the art will appreciate that the soft tissue displacement feature 1020 can be simple or complex. Furthermore, the configuration of the soft tissue displacement feature 1020 can be based on specific soft tissue the soft tissue displacement feature 1020 is intended to engage, hold/retain, and/or displace.	360	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, the soft tissue displacement feature 1020 can simply be a surface of a side of the body 900 (e.g., lateral side 924). In other embodiments, the soft tissue displacement feature 1020 can include a recess, slot, or channel configured to engage with the soft tissue when the resection guide 820c is in use. In one embodiment, the soft tissue displacement feature 1020 is configured to engage with the soft tissue and/or displace the soft tissue while not damaging the soft tissue, or at least mitigating damage to the soft tissue.	361	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In the illustrated embodiment, the soft tissue displacement feature 1020 includes a superior protrusion 1022 and an inferior protrusion 1024. Those of skill in the art will appreciate that the soft tissue displacement feature 1020 may include the superior protrusion 1022, the inferior protrusion 1024, or both. The superior protrusion 1022 and/or inferior protrusion 1024 may also be referred to as lips and/or tabs.	362	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The superior protrusion 1022 and/or inferior protrusion 1024 guide and/or retain a specific soft tissue in a particular location during use of the resection guide 820c. In the illustrated embodiment, the particular location may be a part of the lateral side 924 between the superior protrusion 1022 and the inferior protrusion 1024. In the illustrated embodiment, the specific tissue may be an Extensor Hallucis Longus (EHL) tendon which typically extends from the extensor hallucis longus muscle towards the big toe, hallux.	363	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, the superior protrusion 1022 may have a planar superior surface and a sloped inferior surface. The planar superior surface may also serve as a handle and/or finger position for a user as a user positions the resection guide 820c during use. The sloped inferior surface can facilitate displacement of the soft tissue towards the lateral side 924 between the superior protrusion 1022 and inferior protrusion 1024. The superior protrusion 1022 may extend two to three times further laterally from the body 900 than the inferior protrusion 1024.	364	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The inferior protrusion 1024 can include a sloped superior surface and a sloped inferior surface. The sloped superior surface can facilitate displacement of the soft tissue towards the lateral side 924 between the superior protrusion 1022 and inferior protrusion 1024. The sloped inferior surface can mitigate damage to other soft tissue while the resection guide 820c is in use.	365	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 10D illustrates that in the example resection guide 820c the second bone attachment feature 910 extends from the superior side 914 to the inferior side 916 at an angle that is not perpendicular to the superior side 914.	366	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 10E is a proximal side view of the resection guide 820c. FIG. 10E illustrates a proximal view of the soft tissue displacement feature 1020. FIG. 10E illustrates that in the example resection guide 820c the first bone attachment feature 908 extends from the superior side 914 to the inferior side 916 at an angle that is perpendicular to the superior side 914. FIG. 10E also illustrates the anchor feature 942. In the illustrated embodiment, the anchor feature 942 is configured to direct a fastener (e.g., K-wire or pin) towards a bone at an angle different from the angle fasteners are deployed using either the first bone attachment feature 908 or the second bone attachment feature 910. In certain embodiments, the anchor feature 942 deploy a fastener at an oblique angle. In the illustrated embodiment, the anchor feature 942 is implemented as a hole configured to receive a fasteners (e.g., K-wire or pin). The anchor feature 942 extends from a surface at or between the superior side 914 and the medial side 922 towards the inferior side 916. Note that in the illustrated embodiment, the anchor feature 942 extends towards the inferior side 916 a relatively short distance (e.g., a few millimeters).	367	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 10E illustrates an embodiment in which the body 900 extends from a medial side M (M Arrow) of a foot bone over a dorsal side D (D Arrow) of the foot bone to a lateral side L (L Arrow) of the foot bone. In this manner, a patient-specific bone engagement feature on an inferior side 916 of the resection guide 820c 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 1004 (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.	368	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 10F is a lateral side view of the resection guide 820c. FIG. 10F illustrates the soft tissue displacement feature 1020. In one embodiment, the soft tissue displacement feature 1020 includes a superior protrusion 1022 and an inferior protrusion 1024 as illustrated in FIG. 10F. However, in another embodiment, the soft tissue displacement feature 1020 may not include an inferior protrusion 1024.	369	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In yet another embodiment, the lateral side 924 of the body 900 may be configured to facilitate placement and/or registration of the resection guides 820c to anatomy of the patient. In one example, the lateral side 924 of the body 900 below the superior protrusion 1022 and between the proximal side 918 and the distal side 920 of the lateral side 924 may be divided into two or more planes (e.g., a proximal plane starting from to the proximal side 918 and a distal plane starting from to the distal side 920). In certain embodiments, the lateral side 924 includes a proximal plane that meets a distal plane at a ridge. Advantageously, in certain embodiments, the proximal plane can be oriented to be parallel or substantially parallel to a longitudinal axis of the medial cuneiform 202 when deployed onto a patient and before the surgical procedure is completed. Similarly, the distal plane can be oriented to be parallel or substantially parallel to a longitudinal axis of the first metatarsal 208 when deployed onto a patient and before the surgical procedure is completed. A ridge between the proximal plane and the distal plane may run vertically between the superior protrusion 1022 and the inferior side 916. In this manner, the proximal plane and/or distal plane can be patient-specific. Of course, a surgeon can give instructions regarding an angle for one or more of the proximal plane and/or distal plane. Alternatively, or in addition, the orientation of the proximal plane and/or distal plane can be a standard orientation.	370	Added by DJM Jan 2024	1/3/24, 4:24 AM

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