Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	TMC-PAT-4	FIG. 11 illustrates one example of an anchor feature 942. The anchor feature 942 may include an anchor and in one embodiment, the anchor may be implemented by way of a hole or opening in a structure configured to guide a fastener into a bone at a predetermined angle in one or more of a dorsal plane, a frontal plane, and a transverse plane.	391	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In the illustrated embodiment, the anchor feature 942 includes an anchor that is positioned near the medial side 922 and extends towards the proximal end 824. The anchor includes a hole sized to receive a fastener such as a K-wire or pin that can be deployed into a bone after passing through the hole. The anchor is configured to guide the fastener along a fifth trajectory 1112. In certain embodiments, the fifth trajectory 1112 is different from one or the other, or both, of the first trajectory 1104 and the second trajectory 1106. Of course, the fifth trajectory 1112 can be the same or substantially the same as the first trajectory 1104 or the second trajectory 1106.	392	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In the illustrated embodiment, the anchor feature 942, such as an anchor may extend from the superior side 914 mediolaterally towards the inferior side 916 for a distance sufficient to guide a fastener in a hole of the anchor feature 942 along a particular trajectory. Those of skill in the art will appreciate that this means that the length of a body of the anchor defining the hole can be minimized to reduce the size, weight and use of material of a resection guide 820c. Alternatively, or in addition, body of the anchor defining the hole to a variety of lengths between the superior side 914 and the inferior side 916.	393	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, a surgeon can determine what values are desired for angles A, B, C, D, and E. In this manner, a surgeon can customize the surgical procedure for a particular patient. Advantageously, the various aspects of the design of the resection guide 820 and/or an accompanying surgical technique and/or complementary components 730 can be done prior to fabrication of one or more components of the osteotomy system. Thus, a surgeon can define or adjust the position of the resection features, the position and/or orientation of the bone attachment features, a height of the body 900 (measured between the superior side 914 and the inferior side 916), and the like. Of course, certain of these aspects may be predefined for a surgeon and/or recommendations made to a surgeon. Alternatively, or in addition, certain of these aspects may be patient-specific while others may be standard based on experience and/or established practice for a particular procedure.	394	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 the position and orientation of the proximal resection feature 902 and distal resection feature 904 and the corresponding cut surfaces a surgeon can form using these resection features can vary depending on the anatomical structures of the patient, the osteotomy procedure being performed, preferences of the surgeon, the nature of the condition, and the like.	395	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 12 illustrates a lateral perspective view of a resection guide 820c according to one embodiment. FIG. 12 illustrates a longitudinal axis 1202 that runs in an AP direction. In certain embodiments, the longitudinal axis 1202 may be coincident with the AP axis 1102. In the illustrated embodiment, the longitudinal axis 1202 is coincident with a longitudinal axis of a cuneiform when the resection guide 820c is positioned for use. Alternatively, or in addition, the longitudinal axis 1202 may be coincident with a longitudinal axis of a metatarsal when the resection guide 820c is positioned for use. In contrast, to the illustration in FIG. 12, where the metatarsal is in a deformed position, the longitudinal axis 1202 may extend in a mediolateral direction.	396	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Whether the longitudinal axis 1202 is coincident with a longitudinal axis of cuneiform or a metatarsal of a TMT, one goal of a surgical procedure to correct a deformity of the metatarsal may include translating the metatarsal in the transverse plane such that a longitudinal axis of the metatarsal is coincident with, or parallel to, the longitudinal axis of the cuneiform as a result of the surgical procedure.	397	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 12 also illustrates a dorsal-plantar (DP) axis 1204 that is perpendicular to the longitudinal axis 1202. FIG. 12 illustrates that the first bone attachment feature 908 is configured to align longitudinally with a dorsal axis 1206 that runs parallel to the longitudinal axis 1202. In the illustrated embodiment, the holes 940 of the first bone attachment feature 908 are configured such that fasteners in the holes are parallel to each other and the pair of fasteners are aligned with the dorsal axis 1206. As described above, a first pair of fasteners deployed in the holes 940 of the first bone attachment feature 908 are directed by the holes 940 along a third trajectory 1108 (See FIG. 11) that is parallel to the first trajectory 1104. In certain embodiments, the position of the first bone attachment feature 908 can be configured to be patient-specific and can be configured to direct the fasteners into approximately a center of the dorsal cortex of a bone such as a cuneiform.	398	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, one or more of the bone attachment features may be positioned along a side of the resection guide in order to aid a surgeon in accurate positioning of the resection guide for the surgical procedure. In one example, the first bone attachment feature 908 may be specifically positioned along the proximal side 918 so that an arm that connects the first bone attachment feature 908 to the body is aligned with the dorsal axis 1206 that runs parallel to the longitudinal axis 1202. In one embodiment, the longitudinal axis 1202 may be coaxial with a long axis of a cuneiform involved in the surgical procedure. In another embodiment, the longitudinal axis 1202 may be coaxial with a long axis of a metatarsal involved in the surgical procedure in a deformed condition (preoperatively). In yet another embodiment, the longitudinal axis 1202 may be coaxial with a long axis of a metatarsal involved in the surgical procedure in a corrected condition (postoperatively).	399	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, the surgeon can use the arm that connects the first bone attachment feature 908 to the body as a guide using fluoroscopy to gauge where the parallel long axis 1202 runs and thereby determine and/or confirm whether the resection guide is in a desired position relative to bone(s) of the patient. Furthermore, this can be done before forming any osteotomies, this can help assure the surgeon that the surgical procedure is proceeding as planned.	400	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 12 also illustrates that the second bone attachment feature 910 is not aligned longitudinally with the first bone attachment feature 908. Instead, the second bone attachment feature 910 is positioned towards the medial side 922 of the resection guide 820c. In the illustrated embodiment, the second bone attachment feature 910 is configured to direct a second pair of fasteners along a fourth trajectory 1110 (See FIG. 11) that is parallel to the second trajectory 1106. FIG. 12 illustrates that the fourth trajectory 1110 is offset from the DP axis 1204 by an angle A. The angle A can be configured to position and direct the pair of fasteners deployed in the second bone attachment feature 910 into approximately a center of a surface of a bone such as a metatarsal that faces the second bone attachment feature 910.	401	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, such as the illustrated embodiment, the position of the second bone attachment feature 910 along the distal side 920 and/or size of the angle A are determined to enable an additional correction to a deformity of anatomy of a patient. Often, when a patient has a deformity that calls for a Lapidus surgical procedure to correct the deformity, the patient also has a condition in which the metatarsal has rotated medially about the longitudinal axis 1202 (e.g., AP axis) such that sesamoids near the distal end of the metatarsal extend laterally rather than plantarly. Advantageously, embodiments of the present disclosure enable correction of both the orientation of the metatarsal as well as rotation of the metatarsal within the frontal plane to correct the position of the sesamoids.	402	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In the illustrated embodiment, angle A can be set to enable a rotation (sometimes referred to as a derotation) of the metatarsal in a frontal plane from a deformed position to a corrected position. Advantageously, as with the various other aspects of the resection guide 820c and/or a surgical procedure based on the teachings of the present disclosure, the size of angle A and/or the position of second bone attachment feature 910 can be patient-specific and/or can be determined at least in part based on a model of one or more bones of a patient and/or a model for a resection guide 820c. In certain embodiments, angle A can range from about 2 degrees to about 60 degrees.	403	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The rotational correction of a bone such as a metatarsal is based on an initial position of fasteners deployed in the second bone attachment feature 910 and/or first bone attachment feature 908. In the illustrated embodiment, a first fastener or first pair fasteners of the first bone attachment feature 908 and a second fastener or second pair fasteners are initially deployed such that the fasteners are not aligned with each other along the longitudinal axis 1202 and/or dorsal axis 1206.	404	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Certain embodiments of the present disclosure leverage the position of fasteners (e.g., pins) deployed in the first bone attachment feature 908 and in the second bone attachment feature 910 for multiple purposes. First, the fasteners can be used to indicate for a surgeon the trajectories of osteotomies formed using the proximal resection feature 902 and/or the distal resection feature 904 that are directed along trajectories that are parallel to trajectories that the fasteners are deployed in one or more bones. Second, the fasteners serve to retain the resection guide 820c and keep the resection guide 820c in place while osteotomies are formed. And third, the fasteners are positioned and/or oriented for use to facilitate and aid in reduction of the osteotomies and/or correction of bones as part of the reduction. In the illustrated embodiment, the fasteners in the second bone attachment feature 910 enable rotational correction of the metatarsal as the fasteners of the second bone attachment feature 910 are brought towards and into alignment with the fasteners of the first bone attachment feature 908.	405	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 the proximal resection feature 902 and/or distal resection feature 904 can have an open end. Alternatively, or in addition, the proximal resection feature 902 and/or distal resection feature 904 can be connected to the body 900 between the ends and both ends can be open ends.	292	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, the proximal resection feature 902 and/or distal resection feature 904 can be defined based on, in connection with, and/or may be defined at least partially based on a bone model 404 of one or more bones of a midfoot of a patient. The bone model 404 provides a detailed and accurate representation of the midfoot bones of the patient. Using the apparatuses, systems, and/or methods of the present disclosure the resection guide 820b and/or its components such as the proximal resection feature 902 and distal resection feature 904 can be configured for a specific patient, for a specific surgical procedure, and/or according to specific user instructions and/or preferences of a user (e.g., surgeon).	293	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, the first trajectory 902 is wholly or at least partially determined based on a bone model 404 of the patient’s foot. In particular, the bone model 404 may be of one or more bones, joints, and/or tissues of a midfoot of the patient. The bone model 404 is defined based on medical imaging of the patient’s foot such that the bone model 404 and surfaces and structures of the bone model 404 are highly accurate representations of the actual midfoot bones of a particular patient. The accuracy of the bone model 404 is such that any protuberance, eminence, bony topography, anatomical features, calcifications, void, divot, concave section, sesamoid, bone spur or other feature on, or extending from, a bone of a patient are represented in the bone model 404 (including on surfaces of model bones of the bone model 404).	294	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Alternatively, or in addition, the second trajectory 904 can be wholly or at least partially determined based on one or both of the bone model 404 and the first trajectory 902. For example, in one embodiment, the bone model 404 is used to determine, at least in part, the second trajectory 904. Alternatively, the second trajectory 904 can be defined to be a certain offset, orientation, and/or angle in relation to the first trajectory 902.	295	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Thus, upon desired positioning of the resection guide 820b for use, the proximal resection feature 902 may be positioned over at least a portion of a bone such as a first medial cuneiform or other midfoot bone while the distal resection feature 904 may be positioned over, for example, a portion of another bone such as a first metatarsal 208. In one embodiment, the proximal resection feature 902 is positioned close to the distal end of a first cuneiform and the distal resection feature 904 is positioned near a proximal end of the first metatarsal. The proximal resection feature 902 and distal resection feature 904 are positioned to guide resection of one or more midfoot bones during a surgical osteotomy for correcting a condition.	296	Added by DJM Jan 2024	1/3/24, 4:24 AM

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