Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	TMC-PAT-4	Advantageously, the system 700 can help a surgeon overcome one or more of the challenges in performing an osteotomy procedure, particularly on small bones of a hand or of a foot of a patient, such as on the forefoot, midfoot, or hindfoot. One challenge during an osteotomy procedure can be maintaining control of, and/or position, and/or orientation of a bone, one or more bones, and/or bone pieces/fragments, particularly once a resection or dissection is performed. Advantageously, the fasteners 710, resection guide(s) 720, and/or complementary components 730 can be configured to assist in overcoming this challenge.	264	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, system 700 can help a surgeon in positioning, placing, and/or orienting a resection guide accurately. Modern techniques may include preoperative planning, simulation, or even practice using computer models, 3D printed models, virtual reality systems, augmented reality systems or the like. However, simulations and models are still different from actually positioning a resection guide on a patient’s bone, joint, or body part during the procedure. System 700 can include a number of features, including patient-specific features, to assist the surgeon with the positioning. In one embodiment, the resection guide 720 can include one or more landmark registration features 728.	265	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, the system 700 can help a surgeon in securing guides of the osteotomy system 700, such as a resection guide, as well as how to readily remove the guide (e.g., resection guide) without disturbing a reduction, shifting, reorienting, or repositioning one or more bones or parts of bones while removing the guide. In certain embodiments, the system 700 is configured to permit removal of a guide while keeping temporary fasteners in place for use in subsequent steps of an osteotomy procedure. Alternatively, or in addition, system 700 may facilitate positioning of temporary fasteners during one step of a wedge osteotomy procedure for use in a subsequent step of the wedge osteotomy procedure. Removal of a guide during an osteotomy procedure can be particularly challenging where translation and/or rotation of the bones involved in the osteotomy procedure is required for the success of the osteotomy procedure. Advantageously, system 700 accommodates translation and/or rotation of the bones during the osteotomy procedure while facilitating a successful outcome for the osteotomy procedure.	266	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, the components of the system 700 can be specifically designed for a particular patient. Alternatively, or in addition, the components of the system 700 can be specifically designed for a class of patients. Each of the components of system 700 can be designed, adapted, engineered and/or manufactured such that each feature, attribute, or aspect of the component is specifically designed to address one or more specific indications present in a patient. Advantageously, the cuts made for the osteotomy procedure can be of a size, position, orientation, and/or angle that provides for an optimal osteotomy with minimal risk of undesirable resection. In one embodiment, the components of system 700 can be configured such that an osteotomy is performed that enables a correction in more than one plane in relation to the parts of the body of the patient. For example, cut channels or resection features 722 in a resection guide 720 can be oriented and configured such that when the bones are fused/fixated the correction results from translation, rotation, and/or movement of bones or bone parts in two or more planes (e.g., sagittal and transverse) once the fragments or bones are reduced.	267	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, the exemplary system 700 may include a plurality of fasteners 710, resection guides 720, and/or complementary components 730. For example, a surgeon may plan to resect a plurality of osteotomies from the bone(s) in order to accomplish a desired correction. In one example, one or more wedge segments may be resected from a medial side of a patient's foot and another one or more wedge segments may be resected from a lateral side of the patient's foot. These wedge segments may extend part way into the foot, or through from one side of the foot to the other. Of course, multiple wedge segments may be formed on one side of the foot as well.	268	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Additionally, a surgeon may use one or more components in an exemplary system 700 to make multiple cuts in the bone(s). The multiple cuts may be centered over or around an apex of a deformity or positioned at other locations within the foot such that when the multiple cuts are made, any resected segments removed, or added bone void fillers introduced, and/or bones and/or bone fragments translated and/or rotated the combined angles, surfaces, removed segments, and/or added portions cooperate to provide a desired correction. Each of the components of the exemplary system 700 can be identified, defined, and reviewed using the apparatuses, systems, and/or methods of the present disclosure.	269	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, the components of system 700 may be made as small as possible to minimize the amount of soft tissue that is opened in the patient for the osteotomy procedure. Alternatively, or in addition, walls and/or sides of the components may be beveled and/or angled to avoid contact with other hard tissue or soft tissues in the operating field for the osteotomy procedure.	270	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 for certain osteotomy procedures a complementary component 730 may not be needed or a given complementary component 730 may be optional for use in the osteotomy procedure. Similarly, those of skill in the art will appreciate that certain features of the fasteners 710, resection guides 720, and/or complementary components 730 can be combined into one or more of apparatus or devices or may be provided using a plurality of separate devices.	271	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	FIG. 8 illustrates an exemplary system 800, according to one embodiment. The system 800 may include one or more fasteners 810, such as fasteners 710, a resection guide 820, such as resection guide 820a or resection guide 820b or resection guide 820c and may include one or more other complementary components 830. The resection guides 820a, 820b, 820c facilitate resection of one or more bones of a patient for a surgical procedure.	272	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In one embodiment, the resection guides 820a, 820b, 820c include a body that includes a proximal side, a distal side, a medial side, a lateral side, a superior side, and an inferior side. The body includes a bone engagement feature, a resection feature, and a bone attachment feature. In certain embodiments, the body may also include a window and/or one or more landmark registration features. In another embodiment, a resection guide 820a, 820b, 820c may include one member of a coupler configured to engage a corresponding member of the coupler coupled to an alignment guide.	273	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The resection features 822 guide a surgeon in performing a resection by facilitating keeping a cutting tool in line with and/or within an opening of the resection features 822 (at a desired trajectory relative to one or more bones of the patient). In the illustrated embodiments, the resection features 822 are shaped like slots or channels and include two closed ends. In another embodiment, a resection feature 822 may include an open end and a closed end.	274	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	One difference between embodiments of the resection guides 820a, 820b, 820c may be the number of resection features 822. In the illustrated embodiments, resection guide 820a includes a single resection feature 822a. Resection guides 820b, 820c illustrate alternative embodiments that include two resection features 822a, 822b. In other embodiments, the resection guides 820, 820b, 820c may include one resection feature 822, two resection features 822, three resection features 822, four resection features 822, or the like.	275	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In the illustrated embodiments, resection guides 820 include a proximal end 824 and a distal end 826. The resection guide 820a includes a single resection feature 822a. The single resection feature 822a may extend through the body from a superior side of the body to an inferior side. The resection feature 822a may be configured to guide a cutting tool to form a first osteotomy in a first bone along a first trajectory and a second osteotomy in a second bone along a second trajectory. The first trajectory and second trajectory may be determined based on an angle of at least of portion of the single resection feature 822a through the body. In certain embodiments, one or more of the first trajectory and the second trajectory may be at least partially determined based on a bone model of a patient’s foot. The bone model may be defined at least in part based on medical imaging of the patient’s foot. The first trajectory and the second trajectory determined at least in part based on the bone model may determine final trajectory or a proposed trajectory that a surgeon can then alter or revise as needed to accomplish a desired outcome.	276	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Advantageously, the angle of each resection feature (e.g., slot or part of a slot), and thus the first trajectory and/or the second trajectory relative to: another resection feature, to one or more bones, to one or more bone surfaces, to one or more reference points, to one or more reference lines, and/or to one or more reference planes can be determined, selected, or indicated by a surgeon before the resection guide 820 is fabricated. In addition, a surgeon can designate which sides of the resection features 822 are open end or closed end.	277	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	The single resection feature 822a may be implemented in the form of a single slot and/or a plurality of connected slots. For example, the single resection feature 822a may include a proximal slot 828 closer to a proximal end 824 and a distal slot 832 closer to the distal end 826 and a connector 834 that connects the proximal slot 828 to the distal slot 832.	278	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In the illustrated embodiments, resection guides 820b, 820c include a two resection features 822 (e.g., resection feature 822a and resection feature 822b). Resection feature 822a may be similar to, or may be, a proximal slot 828 and may be near the proximal end 824. Resection feature 822b may be similar to, or may be, a distal slot 832 and may be near the distal end 826. Thus, as with a proximal slot 828 and/or a distal slot 832, the resection feature 822a and resection feature 822b can guide a cutting tool to form a first osteotomy in a first bone and a second osteotomy in a second bone, respectively. The first osteotomy in the first bone along the first trajectory and the second osteotomy in the second bone along the second trajectory may have a first trajectory and a second trajectory determined based on an angle of at least of portion of the respective resection feature 822a, 822b through the body. In certain embodiments, one or more of the first trajectory and the second trajectory may be at least partially determined based on a bone model of a patient’s foot. The bone model may be defined at least in part based on medical imaging of the patient’s foot. The first trajectory and the second trajectory determined at least in part based on the bone model may determine final trajectory or a proposed trajectory that a surgeon can then alter or revise as needed to accomplish a desired outcome. The bone model may be a model of both the first bone and the second bone or of one of the first bone and the second bone. In one embodiment, the first bone is a cuneiform, and the second bone is a metatarsal. In certain embodiments, the cuneiform and the metatarsal may be of a patient and may be a cuneiform and a metatarsal that are both part of a particular joint such as a TMT joint.	279	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 resection guide 820 may have a variety of shapes, sizes and configurations. In one embodiment, these attributes can each be customized and adapted to meet needs or preferences of patients, a patient’s anatomy, the nature of the deformity, and/or surgeon preferences. Advantageously, the features of the resection guides 820 can facilitate one or more osteotomies as well as other steps in a surgical procedure.	280	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In the illustrated embodiment, each of the resection guides 820a, 820b, 820c may be configured for use on a medial side of a midfoot of a patient, with the side visible in FIG. 8 facing away from the bone(s). The parts of the resection feature 822a or resection features 822a, 822b may be positioned and oriented relative to each other to facilitate an arthrodesis surgical procedure that remediates a deformity with a goal of correcting a deformity.	281	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	In certain embodiments, the resection guides 820a, 820b, 820c include a patient-specific bone engagement feature configured to engage at least a portion of at least one foot bone to assist in positioning the resection guide, a first bone attachment feature configured to accept a first fastener that engages the first bone, and a second bone attachment feature configured to accept a second fastener that engages the second bone. The resection guides 820a, 820b, 820c also include a window 836. In one embodiment, the window 836 is positioned in the body between a proximal slot 828 and a distal slot 832. In one embodiment, the window 836 extends from a superior side of the body to an inferior side of the body. In another embodiment, the window 836 is radiolucent such that the window 836 provides visibility of at least one anatomical structure inferior to the resection guide, when the resection guide is in use. In one embodiment, the window 836 is an opening or hole. In another embodiment, the window 836 may be a structure that includes a plurality of openings or holes. In yet another embodiment, the window 836 may be a structure that is opaque to light but is radiolucent when used with an imaging device such as an X-ray machine fluoroscopy machine, or other imaging device. These aspects, as well as others, will be described in further detail in subsequent paragraphs.	282	Added by DJM Jan 2024	1/3/24, 4:24 AM
View Edit Delete	TMC-PAT-4	Alternatively, or in addition, the resection guide 820a and resection guide 820b in the illustrated embodiments include a member of a coupler configured to engage a corresponding member of the coupler coupled to an alignment guide. Those of skill in the art appreciate that various designs of a coupler may be used. In the illustrated embodiment, the coupler may include an opening 838 that may extend from the superior side into the body through to the inferior side. The opening 838 may be configured to accept a post or extension from part of the alignment guide, when the post or extension is inserted into the opening 838.	283	Added by DJM Jan 2024	1/3/24, 4:24 AM

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