Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-10	In the embodiment of Figures 3A through 3D, the guide features may guide a reciprocating planar blade, such as that of a surgical bone saw, that forms planar cuts in the first cuneiform 210 and the first metatarsal 230. Thus, the guide features may take the form of a first slot 350 and a second slot 352, which may be positioned toward the center of the body 310, on opposite sides of the joint probe 320. Thus, upon proper positioning of the cutting guide 300, the first slot 350 may be positioned over the first cuneiform 210 to facilitate resection of the first cuneiform 210, while the second slot 352 may be positioned over the first metatarsal 230 to facilitate resection of the first metatarsal 230.	92	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Returning to Figures 3A through 3D, the body 310 may further have features that facilitate proper positioning of the cutting guide 300 on the first cuneiform 210 and the first metatarsal 230. More specifically, the body 310 may have a first bone indicator 360 with the text “CUN,” indicating that the end of the body 310 with the first bone indicator 360 is to be positioned over the first cuneiform 210. Similarly, the body 310 may have a second bone indicator 362 with the text “MET,” indicating that the end of the body 310 with the second bone indicator 362 is to be positioned over the first metatarsal 230. In addition, the body 310 may have a side indicator 370 with the text “LEFT,” indicating that the cutting guide 300 is to be used in connection with the patient’s left foot. The side indicator 370 may be particularly helpful when bunion corrections are to be provided on both of the patient’s feet. In such a case, the surgeon may manufacture or receive two separate cutting guides: one for the left foot (the foot 200 of Figure 2) and another for the right foot (not shown).	94	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Figure 4 is a perspective view of the foot 200 of Figure 2, with the cutting guide 300 of Figures 3A, 3B, 3C and 3D properly positioned on the first cuneiform 210 and the first metatarsal 230, but as yet not attached to the first cuneiform 210 and the first metatarsal 230. The surgeon has made the incision(s) to expose the dorsal surfaces of the first cuneiform 210 and the first metatarsal 230, and has inserted the cutting guide 300 such that the cuneiform apposition portion 342 (identified by the first bone indicator 360 on the outward-facing side 332 of the body 310) is resting on the corresponding dorsal surface of the first cuneiform 210, and the metatarsal apposition portion 344 (identified by the second bone indicator 362 on the outward-facing side 332 of the body 310) is resting on the corresponding dorsal surface of the first metatarsal 230. Since the cuneiform apposition portion 342 and the metatarsal apposition portion 344 are contoured to match the bone surfaces on which they rest, the body 310 may readily slide into its proper position on the first cuneiform 210 and the first metatarsal 230.	95	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Notably, the joint probe 320 (not visible) may reside between the first cuneiform 210 and the first metatarsal 230 (i.e., distal to the first cuneiform 210 and proximal to the first metatarsal 230). The surgeon may need to cut the metatarsocuneiform joint between the first cuneiform 210 and the first metatarsal 230 to form a space between the first cuneiform 210 and the first metatarsal 230 to receive the joint probe 320. Positioning the joint probe 320 in this space may further help to ensure that the cutting guide 300 is properly aligned relative to the first cuneiform 210 and the first metatarsal 230.	96	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Figure 5 is a perspective view of the foot 200 of Figure 2, with the cutting guide 300 of Figures 3A, 3B, 3C, and 3D properly positioned on the first cuneiform 210 and the first metatarsal 230 and attached to the first cuneiform 210 and the first metatarsal 230 in preparation for resection of the first cuneiform 210 and the first metatarsal 230. Specifically, pins 500 may be inserted through the holes 340 in the body 310 and anchored in the first cuneiform 210 and the first metatarsal 230. Each of the pins 500 may have a sharp and/or threaded distal end that can penetrate and/or readily be retained in the bone of the first cuneiform 210 or the first metatarsal 230. Additionally or alternatively, a drill or other hole-forming instrument may be used to pre-form holes in the first cuneiform 210 and/or the first metatarsal 230 to receive the distal ends of the pins 500.	97	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	As shown, the body 310 may have two holes 340 positioned over the first cuneiform 210, and two holes 340 positioned over the first metatarsal 230. This is merely exemplary; in some embodiments, a cutting guide may be secured to one of the first cuneiform 210 and the first metatarsal 230 or may be secured to either of the first cuneiform 210 and the first metatarsal 230 with one pin 500, or with more than two pins 500. Further, in some alternative embodiments, different fasteners may be used, such as screws, clamps, clips, and/or the like.	98	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Once the cutting guide 300 has been secured relative to the first cuneiform 210 and the first metatarsal 230, the first cuneiform 210 and the first metatarsal 230 may be resected. In some embodiments, a reciprocating blade may be inserted into the first slot 350 and moved medially and laterally, between opposite ends of the first slot 350, to make a planar cut that removes the distal end of the first cuneiform 210. Similarly, the reciprocating blade (or a different reciprocating blade) may be inserted into the second slot 352 and moved medially and laterally, between opposite ends of the second slot 352, to make a planar cut that removes the proximal end of the first metatarsal 230. The cuts in the first cuneiform 210 and the first metatarsal 230 may be made in either order. In either case, once both cuts are made, the metatarsocuneiform joint between the first cuneiform 210 and the first metatarsal 230 may be removed, resulting in exposure of “bleeding” bone at the distal end of the first cuneiform 210 and the proximal end of the first metatarsal 230. The cutting guide 300 may be removed, along with some or all of the pins 500. If desired, at least two of the pins 500 may remain in place and used to attach a distractor (not shown) to the first cuneiform 210 and the first metatarsal 230, such that the distractor can temporarily widen the space between the first cuneiform 210 and the first metatarsal 230 to allow for fenestration and/or other preparation of the cut surfaces of the first cuneiform 210 and the first metatarsal 230. Once such preparation has been carried out, the remaining pins 500 may also be removed.	99	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The resulting bleeding and/or prepared bone may readily grow together and fuse, upon abutment of the distal end of the first cuneiform 210 to the proximal end of the first metatarsal 230, particularly with application of some compression across the juncture of the two bones. Since the positions and orientations of the first slot 350 and the second slot 352 were carefully selected to provide the proper correction, the first metatarsal 230 may be positioned to abut the first cuneiform 210, resulting in reorientation of the first metatarsal 230 to a desired orientation, relative to the lateral direction 260 and the plantar direction 280 and/or the dorsal direction 290. Further, the surgeon may optionally rotate the first metatarsal 230, relative to the first cuneiform 210, about an axis perpendicular to the cutting planes, if desired.	100	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Figures 21A, 21B illustrate a perspective view of an alignment guide and of a first cuneiform and a first metatarsal with one embodiment of a patient-specific cutting guide according to one embodiment.	35	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	One general aspect of the present disclosure can include a method for making a patient specific cutting guide configured to mitigate a condition present in a patient. The method includes accessing a bone model of one or more bones of a patient based on the condition and/or the bone model; defining one or more guide features of a preliminary cutting guide model for an osteotomy procedure, the preliminary cutting guide model may include a superior surface and an inferior surface; defining at least a portion of the inferior surface of the preliminary cutting guide model according to a topographical surface of at least one bone of the bone model such that the inferior surface substantially matches a contour of the topographical surface; and where the preliminary cutting guide model is configured for fabrication of a patient specific cutting guide corresponding to the preliminary cutting guide model.	8	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Implementations may include one or more of the following features. The method may include defining one or more alignment features of the preliminary cutting guide model for the osteotomy procedure. Accessing the bone model further may include: modifying a bone model may include a first modeled bone and a second modeled bone of a joint of the patient such that the first modeled bone is rotated about a longitudinal axis of the first modeled bone from a first position to a second position; defining a first cut surface in the first modeled bone, where the first cut surface is perpendicular to the longitudinal axis of the first modeled bone; defining a first angle for a second cut surface of the second modeled bone, the first angle measured relative to the first cut surface and extends inferiorly away from the first cut surface; defining a second angle for the second cut surface of the second modeled bone, the second angle measured relative to the first cut surface and configured to mitigate the condition; modifying the bone model of the first modeled bone to include the first cut surface and the second modeled bone to include the second cut surface; and where the one or more guide features of a preliminary cutting guide model are configured to enable a surgeon to form the first cut surface and the second cut surface.	9	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Defining one or more guide features of the preliminary cutting guide model further may include: defining a first slot configured to guide formation of a first cut surface of a first bone of the patient corresponding to a first modeled bone; defining a second slot configured to guide formation of a second cut surface of a second bone of the patient corresponding to a second modeled bone; and where the first slot and second slot are positioned such that fixing the first cut surface of the first bone to the second cut surface of the second bone mitigates the condition. The method may include selecting the preliminary cutting guide model from a repository of template cutting guide models, each template cutting guide model configured for an osteotomy procedure configured to correct one of a plurality of conditions. The method may include defining a coupler configured to engage an alignment guide, the alignment guide configured to indicate a resulting alignment of patient body parts upon completion of the osteotomy procedure. The bone model is derived from patient imaging data generated while the patient places their weight on at least one joint involved in the osteotomy procedure.	10	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	One general aspect of the present disclosure can include a system for correcting a condition present in a patient. The system may include a cut guide that may include: a first guide feature configured to define a first cut surface configured for resection of a first metatarsal of a patient, a second guide feature configured to define a second cut surface configured for resection of a medial cuneiform of a patient, an inferior side may include a bone engagement surface shaped to match a first surface of the first metatarsal and a second surface of the medial cuneiform, a medial cuneiform alignment feature coupled to the medial cuneiform, where one of the first guide feature and the second guide feature is configured based on patient imaging data such that fusion of the first metatarsal at the first cut surface to the medial cuneiform at the second cut surface mitigates the condition. The system includes a first metatarsal alignment feature coupled to the first metatarsal, the first metatarsal alignment feature configured to enable a user to rotate the first metatarsal from a malrotation position to a desired rotation position; and a compressor/distractor configured to engage the medial cuneiform alignment feature and the first metatarsal alignment feature and compress the first cut surface of the first metatarsal against the second cut surface of the medial cuneiform.	11	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Implementations may include one or more of the following features. The system where: the first metatarsal alignment feature may include a pin guide configured to position alignment pins for a desired rotation angle of the first metatarsal about its longitudinal axis; the compressor/distractor may include a pair of legs that are closer to each other at distal end of each leg than at a proximal end of each leg.	12	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Figure 4 is a perspective view of the foot of Figure 2, with the cutting guide of Figures 3A, 3B, 3C and 3D properly positioned on the first cuneiform and the first metatarsal, but as yet not attached to the first cuneiform and the first metatarsal.	17	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Figure 5 is a perspective view of the foot of Figure 2, with the cutting guide of Figures 3A, 3B, 3C, and 3D properly positioned on the first cuneiform and the first metatarsal and attached to the first cuneiform and the first metatarsal in preparation for resection of the first cuneiform and the first metatarsal, according to one embodiment.	18	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Figure 6A is a perspective view of the foot of Figure 2, after resection of the first cuneiform and the first metatarsal, removal of the cutting guide, and placement of the first metatarsal to abut the first cuneiform, according to one embodiment.	19	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Figure 13 illustrates a perspective view of a first cuneiform and first metatarsal with one embodiment of a cutting guide secured to the two bones.	27	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Figure 14 illustrates a perspective view of a first cuneiform and first metatarsal with one embodiment of a cutting guide secured to the two bones.	28	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Figure 15 illustrates an exemplary embodiment of a parallel distractor that can be used with certain embodiments.	29	Added by DJM 2 2022	2/25/22, 12:00 AM

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