Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	TMC-PAT-4	Or the orientation of the proximal plane and/or distal plane can be predefined such that the orientation selected is based on criteria for a certain set of characteristics for a patient (e.g., similar to or the same as patient-matched). Where the orientation of the proximal plane and/or distal plane is set based on a patient-matched embodiment, a plurality of resection guides 820c may be pre-fabricated and the one selected for a particular surgical procedure may be selected based on a set of patient-matched criteria.	371	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 10G is a medial side view of the resection guide 820c. FIG. 10G illustrates the anchor feature 942 and a sloped surface between the medial side 922 and the superior side 914 and a sloped surface between the medial side 922 and the inferior side 916. These sloped surfaces may facilitate deployment of the resection guide 820c and/or may enable deployment with smaller incisions and/or may mitigate damage to surrounding soft tissue during a surgical procedure.	372	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 11 illustrates a medial side view of resection guide 820c according to one embodiment. This figure illustrates trajectories for different aspects of the resection guide 820c. FIG. 11 also illustrates positions and/or angles (e.g., orientation) of one, or both of the resection features (e.g., proximal resection feature 902 and/or distal resection feature 904) and first bone attachment feature 908 and second bone attachment feature 910 relative to each other based on patient imaging data. FIG. 11 also illustrates positions and orientations of resection features and/or bone attachment features in relation to a reference axis 1102, (AP (Anterior-Posterior) axis 1102 that is coincident to a longitudinal axis that extends through a cuneiform and metatarsal of a TMT joint when the guide is used).	373	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 either the proximal resection feature 902 or the distal resection feature 904 or both the proximal resection feature 902 and the distal resection feature 904 may be angled and/or oriented in relation to the AP axis 1102 and/or a ML (Medial-Lateral) axis (not shown, that extends into and out of FIG. 11) and/or a DP (Dorso-Plantar) axis (vertical within FIG. 11). For example, in certain embodiments, the distal resection feature 904 may be oriented such that an osteotomy formed using the distal resection feature 904 is at an angle perpendicular to the AP axis 1102 and the proximal resection feature 902 may be oriented such that an osteotomy formed using the proximal resection feature 902 is at an angle non perpendicular to the AP axis 1102 and determined to provide correction of orientation of the bones fused in the surgical procedure. Similarly, the angles for the proximal resection feature 902 and/or distal resection feature 904 can be defined relative to the ML axis and/or the DP axis. Alternatively, or in addition, both the proximal resection feature 902 and the distal resection feature 904 can be defined to direct formation of an osteotomy that extends along a trajectory that is angled relative to the AP axis 1102, ML axis, and/or DP axis in order to provide a deformity correction.	374	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In the illustrated embodiment, the proximal resection feature 902 is positioned between the proximal side 918 and the window 906. As explained, the proximal resection feature 902 extends through the body 900 from the superior side 914 to the inferior side 916 along a first trajectory 1104 in a plantar direction at an angle A in relation to AP axis 1102. This orientation of the proximal resection feature 902 enables a cutting tool forming a first osteotomy into a bone to form a cut surface that is also at angle A relative to AP axis 1102. In certain embodiments, angle A can range between about 0 degrees to about 170 degrees. In certain embodiments, angle A may start at 0 degrees and then increase to a positive number of degrees as illustrated or decrease to a negative number of degrees depending on how a surgeon may prescribe adjustments for a correction.	375	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Similarly, the distal resection feature 904 is angled relative to the AP axis 1102. In the illustrated embodiment, the distal resection feature 904 extends through the body 900 from the superior side 914 to the inferior side 916 along a second trajectory 1106 in a plantar direction at an angle B in relation to AP axis 1102. This orientation of the distal resection feature 904 enables a cutting tool forming a second osteotomy into a bone to form a cut surface that is also at angle B relative to AP axis 1102. In certain embodiments, angle B can range between about 0 degrees to about 170 degrees. In certain embodiments, angle B may start at 0 degrees and then increase to a positive number of degrees as illustrated or decrease to a negative number of degrees depending on how a surgeon may prescribe adjustments for a correction. In the illustrated embodiment, the angle B is a 90-degree angle. Making one of the angles A or B for the first trajectory 1104 or second trajectory 1106 perpendicular to the AP axis 1102 can be desirable since a perpendicular cut or resection may be easier to complete, and in particular may be easier to complete on certain bones.	376	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The proximal resection feature 902 and the distal resection feature 904 can be oriented relative to the AP axis 1102, ML axis, and/or DP axis and/or relative to each other. Thus, the proximal resection feature 902 and/or distal resection feature 904 can be angled in one or more planes to provide a biplanar or multiplanar correction.	377	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Similarly, those of skill in the art will appreciate that just as the angle of orientation for the resection features 902, 904 can be predefined and determined, the orientation of one or more holes 940 of one or more bone attachment features 908, 910 can be predefined and determined. Thus, a first bone attachment feature 908 and/or second bone attachment feature 910 can direct a fastener into a bone along a predetermined trajectory.	378	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, the first bone attachment feature 908 (e.g., holes 940 of the first bone attachment feature 908) may direct a first fastener, or set of fasteners, into a bone at an angle C relative to the AP axis 1102. The angle C may be the same, or a similar, to angle A. Accordingly, the first bone attachment feature 908 directs the first fastener, or set of fasteners, into the bone along a third trajectory 1108 that is parallel or substantially parallel to the first trajectory 1104.	379	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In addition, the second bone attachment feature 910 (e.g., holes 940 of the second bone attachment feature 910) may direct a second fastener, or set of fasteners, into a bone at an angle D relative to the AP axis 1102. The angle D may be the same, or a similar, to angle B. Accordingly, the second bone attachment feature 910 directs the second fastener, or set of fasteners, into the bone along a fourth trajectory 1110 that is parallel or substantially parallel to the second trajectory 1106. In certain embodiments, where angle B is a 90-degree angle, angle D may also be a 90-degree angle.	380	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, the first bone attachment feature 908 can direct the fasteners by way of holes 940 that extend into the body 900 at an angle C that provides the third trajectory 1108. The second bone attachment feature 910 can direct the fasteners by way of holes 940 that extend into the body 900 at an angle D that provides the fourth trajectory 1110. The angled holes 764 cause the fasteners to enter the bone at substantially the same angle as the hole extends into the body 900.	381	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, fasteners deployed in holes 940 of the first bone attachment feature 908 and/or second bone attachment feature 910 can serve more than one purpose. First, the fasteners may retain the resection guide 820c in place during formation of the osteotomies. Second, the fasteners may guide a surgeon regarding the planned trajectories for an osteotomy through the proximal resection feature 902 and/or distal resection feature 904. The surgeon can use the deployed fasteners as a proxy for where the osteotomies in the resection features will be.	382	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, a surgeon may use medical imaging to confirm that the trajectories of deployed fasteners into the bone(s) using the holes 940 are where the surgeon had planned them and/or wants them, and that the surgeon still wants to proceed with the resections. If the surgeon is not comfortable proceeding with the procedure with the given resection guide 820c after reviewing the trajectories indicated by the fasteners under fluoroscopy, in certain embodiments, the surgeon may deploy an alternative resection guide 820c that is configured to provide a different trajectory for one or more resection cuts into one or more bones. Alternatively, the surgeon may make a different change to the surgical plan to accommodate the needs of the patient and/or preferences of the surgeon.	383	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one example, when a surgeon uses the resection guide 820c, the surgeon may deploy a first fastener in an opening of first bone attachment feature 908 and a second fastener in an opening of second bone attachment feature 910 into one or more bones of a patient’s midfoot. In one embodiment, the fasteners are made from a radiopaque material, such as metal. Next, a surgeon may use an X-ray or fluoroscopy to see where the first fastener and/or second fastener extend into one or more bones of the midfoot of the patient. Advantageously, the surgeon knows that the trajectories (e.g., third trajectory 1108 and fourth trajectory 1110) of the first fastener and second fastener are parallel to the first trajectory 1104 and/or second trajectory 1106. Thus, the surgeon can visualize where the first trajectory 1104 and second trajectory 1106 will extend into the one or more bones. In this example, the third trajectory 1108 indicates the first trajectory 1104 and the fourth trajectory 1110 indicates the second trajectory 1106.	384	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, each bone attachment feature may include one or more holes 940. More than one or two holes 940 for each bone attachment feature can be advantageous because additional holes 940 can provide a more stable placement of the resection guide 820c. For example, a fastener in a second or third hole can help keep the resection guide 820c from pivoting or rotating about a single fastener in a single hole.	385	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Referring now to FIG. 11, in the illustrated embodiment, the proximal resection feature 902 comprises an opening that starts on the superior side 914 and extends to the inferior side 916. The opening of the proximal resection feature 902 extends through the body 900 along a first trajectory 1104. In the illustrated embodiment, the distal resection feature 904 comprises an opening that starts on the superior side 914 and extends to the inferior side 916. The opening of the distal resection feature 904 extends through the body 900 along a second trajectory 1106.	386	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The opening of the proximal resection feature 902 and/or the opening of the distal resection feature 904 has a width and/or length large enough to accommodate, or accept, a cutting element of a cutting tool. In one embodiment, the opening of the proximal resection feature 902 is configured to guide and/or enable a cutting tool to form a first osteotomy into, and/or through, the bone. Advantageously, the first osteotomy tracks, follows, and/or is aligned with the first trajectory 1104. In one embodiment, the opening of the distal resection feature 904 is configured to guide and/or enable a cutting tool to form a second osteotomy into, and/or through, the bone. Advantageously, the second osteotomy tracks, follows, and/or is aligned with the second trajectory 1106. Thus, a surgeon operating the cutting tool within the opening of the proximal resection feature 902 and the distal resection feature 904 can readily form a first osteotomy and a second osteotomy that matches a design that may have been set out in a model of the resection guide 820c and/or a model of the patient’s bone(s).	387	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, the first trajectory 1104 may be determined and/or defined to be a patient-specific feature. Similarly, the second trajectory 1106 may be determined and/or defined to be a patient-specific feature. Advantageously, using the apparatus, methods, and/or systems of the present disclosure a user may determine and/or at least partially determine the first trajectory 1104 and/or the second trajectory 1106 based on a bone model of at least a portion a bone of the patient that is to receive one or more osteotomies. The bone model of at least a portion of the bone can be derived from, and/or based on, medical imaging of a patient’s foot. In certain embodiments, the bone model used to determine, or at least partially determine, the first trajectory 1104 and/or the second trajectory 1106 is configured to resemble, substantially resemble, or match the anatomy of the patient’s foot.	388	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	As used herein, in certain embodiments, partial determination of the first trajectory 1104 and/or the second trajectory 1106 based on a bone model may mean that the bone model for a bone of a patient that will receive the osteotomies is used together with other imaging data, anatomic data, patient imaging data, patient data, information from a prescription from a doctor, information about surgeon preferences, measurement data taken from the bone model or medical imaging, or the like to determine the first trajectory 1104 and/or the second trajectory 1106.	389	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The first trajectory 1104 may be at least partially determined based on a bone model of at least a portion of a bone of a patient’s foot. The bone model may be based on medical imaging of the patient’s foot and is configured to resemble, significantly resemble, and/or match the anatomy of the patient’s foot. The second trajectory 1106 may be at least partially determined based on a bone model of at least a portion of a bone of a patient’s foot. The bone model may be based on medical imaging of the patient’s foot and is configured to resemble, significantly resemble, and/or match the anatomy of the patient’s foot.	390	Added by DJM Jan 2024	1/3/24, 4:24 AM

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