Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-10	The bone facing side 1230 may be custom contoured to match the shapes of the first cuneiform and/or the first metatarsal. As embodied in Figures 12A through 12F, the bone facing side 1230 may have a cuneiform apposition portion 1242 shaped to lie against the surface of the first cuneiform, and a metatarsal apposition portion 1244 shaped to lie against the surface of the first metatarsal. As shown, the cuneiform apposition portion 1242 may be contoured to match the contour of the surface of the first cuneiform on which it is to rest, and the metatarsal apposition portion 1244 may similarly be contoured to match the contour of the surface of the first metatarsal on which it is to rest. Thus, the body 1210 may have only one stable position and orientation relative to the first cuneiform and the first metatarsal.	143	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The body 1210 may further have guide features that guide a cutter to resect the first cuneiform and the first metatarsal in the manner needed to make the desired correction. For example, the guide features may be used to guide a planar cutting blade, an arcuate cutting blade, a drill or mill, a burr, and/or the like.	144	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In the embodiment of Figures 12A through 12F, 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 and the first metatarsal. Thus, the guide features may take the form of a first slot 1250 and a second slot 1252, which may be positioned toward the center of the body 1210. Thus, upon proper positioning of the cutting guide 1200, the first slot 1250 may be positioned over the first cuneiform to facilitate resection of the first cuneiform, while the second slot 1252 may be positioned over the first metatarsal to facilitate resection of the first metatarsal.	145	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Returning to Figures 12A through 12H, the body 1210 may further have features that facilitate desired translation and orientation of the first metatarsal in order to fuse or join the first cuneiform and the first metatarsal to complete the procedure. For example, in the illustrated embodiment, the cutting guide 1200 may include two alignment features 1260a and 1260b.	147	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In the embodiment of FIG. 12A, one alignment feature 1260a is in the lower right-hand side of the body 1210, the distal side of the body, and the other alignment feature 1260b is on a proximal side of the body 1210. The two alignment features 1260a and 1260b may be separate features, or certain features such as one or more attachment features may serve a dual purpose as both an attachment feature and as an alignment feature. For example, in the embodiment of FIG. 12A, alignment feature 1260b may use the same structure as the bone attachment features and may take the form of holes 1240 that extend from a bone facing side 1230 to the outward-facing side 1232 and/or one or more fixation devices.	148	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In one embodiment, the alignment feature 1260, such as alignment feature 1260a, can include one or more bone attachment features that may take the form of holes 1278 that extend from a bone facing side 1230 to the outward-facing side 1232 and/or one or more fixation devices. In certain embodiments, a pair of parallel holes 1278 form a guide for pins 1280 (See FIG. 13) as part of a bone attachment feature. Advantageously, the holes 1278 may be angled with respect to a bone such as the first metatarsal. The angle for the holes 1278 may be customized based on the patient and the amount of adjustment desired for the first metatarsal.	152	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 13 illustrates a perspective view of a first cuneiform 210 and first metatarsal 230 with one embodiment of a cutting guide 1300 secured to the two bones. The cutting guide 1300 includes pins 1280 in the holes 1240 to secure the cutting guide 1300 to the bones. (Pins 1280 for hole 1240a and hole 1240b and hole 1240c are omitted to facilitate certain disclosure.)	153	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 13 illustrates that in one embodiment, the holes 1240 of each bone attachment feature can be parallel to each other such that pins 1280 in the holes 1240 are parallel to each other. Red line A illustrates that the holes 1240a, 1240b are aligned perpendicular to a resection cut that has been made on the first cuneiform 210 through slot 1350. Pins 1280 in holes 1240a,b may be referred to as cuneiform pins and these parallel cuneiform pins form a line (red line A) perpendicular to a cut plane in the first cuneiform 210. Red line B illustrates that the holes and corresponding parallel pins 1281 (which may be referred to as metatarsal pins) may form a line perpendicular to a cut plane in the first metatarsal 230. The metatarsal pins 1281 are aligned perpendicular to a resection cut (also referred to as a MET cut) that has been made on the first metatarsal 230 through slot 1352.	154	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 14 illustrates a perspective view of a first cuneiform 210 and first metatarsal 230 with one embodiment of a cutting guide 1400 secured to the two bones. The cutting guide 1400 includes pins 1280a-f in the holes 1240 of bone attachment features and the holes 1278 of the alignment features 1260, such as alignment feature 1260a.	155	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	At this stage in a surgical procedure, the cutting guide 1400 is placed on the first cuneiform 210 and the first metatarsal 230 and pins 1280a-d are connected to the bones through the respective holes 1240. Next, a surgeon uses the guide features of the cutting guide 1400 to reset the first cuneiform 210 and the first metatarsal 230. Then, a surgeon may insert pins 1280e,f into holes 1278 of the alignment feature 1260a. Alternatively, in another embodiment, a surgeon may insert pins 1280e,f into holes 1278 of the alignment feature 1260a before resecting the first cuneiform 210 and/or first metatarsal 230.	156	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	As shown, the cutting guide 1200 may have a body 1210 with a monolithic construction and the general shape of a rectangular prism. The body 1210 may reside on the dorsal surfaces of the first cuneiform and the first metatarsal to provide proper alignment of the body 1210 with the metatarsocuneiform joint.	141	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Furthermore, fabricating a cutting guide that is customized to a particular patient and a specific desired correction/adjustment enables correction of a variety of angular deformities (in all 3 planes) of the midfoot or hind foot and ankle where an osteotomy could be used. The alignment features 1260 disclosed in this solution and the corresponding pins formed within a cutting guide that may also include a detachable connector 1270 enable correction procedures for a variety of angular deformities (in all 3 planes) of the midfoot or hind foot and ankle where an osteotomy could be used. For example, embodiments of the procedures and devices herein disclosed can be used to address cavus, and mid foot dislocations, fracture malunion, metatarsal adductus, etc. They can also be used in preparation for joint resurfacing procedures of the foot and ankle to optimize placement of an arthroplasty implant.	159	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Next, with the alignment feature 1260a separated from the body 1210, and pins 1280c,d removed, a user can remove the two parts of the cutting guide 1400 separately. Pins 1280a,b remain in the first cuneiform 210 and pins 1280e,f remain in the first metatarsal 230.	161	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Next, a parallel compressor/distractor 1500 such as the exemplary parallel compressor/distractor 1500 illustrated in FIG. 15 is used to distract the first metatarsal 230 relative to the first cuneiform 210. The user slides holes 1502a,b over pins 1280a,b and holes 1502c,d over pins 1280e,f. This causes a desired rotation and translation of the first metatarsal 230 relative to the first cuneiform 210. When a user places the parallel compressor/distractor 1500 on over these pins 1280a,b,e,f this forces the cut faces of the two bones to become parallel. Advantageously, the cut faces of the two bones can be forced to become parallel because the position, orientation, and angles of the holes 1278 and/or holes of either or both of the alignment feature 1260a and alignment feature 1260b can be predefined and customized for each patient when the cutting guide 1300 is fabricated. This alignment enables parallel compression of the two bones together using the parallel compressor/distractor 1500. Parallel compression enables more effective compression of the two bones together. Next, the space between the resected surfaces of the first cuneiform 210 and the first metatarsal 230 is prepared for fusion. Then, the parallel compressor/distractor 1500 is activated such that the first cuneiform 210 and the first metatarsal 230 are fused together. The parallel compressor/distractor 1500 may include a first leg 1504 and a second leg 1506. At one end of each leg 1504/1506, the leg may include a toe 1508/1510 at its distal end. In one embodiment, the toes 1508/1510 are angled to point towards each other. The angled configuration of the legs 1504/1506 by way of the toes 1508/1510 may apply a torque force at the toes 1508/1510 which may further assist in pressing two bones connected to the parallel compressor/distractor 1500 together.	162	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Referring to FIG. 16, in certain embodiments, a parallel compressor/distractor 1600 such as the exemplary parallel compressor/distractor 1600 having holes 1602 illustrated in FIG. 16 can be used to distract the first metatarsal 230 relative to the first cuneiform 210. The parallel compressor/distractor 1600 may also include a cross joint guide 1604. The user may slide holes 1602a,b over pins 1280a,b and holes 1602c,d (not visible, obscured by holes 1606a,b which are aligned with holes 1602c,d) over pins 1280e,f.	163	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The cross joint guide 1604 may serve as a guide for cross joint fasteners or other kinds of implants or fixation devices that can be installed across a joint between the first cuneiform 210 and the first metatarsal 230. In one embodiment, the cross joint guide 1604 may include one or more bone attachment features that may take the form of holes 1608 that extend from one side of the cross joint guide 1604 to the other side and/or one or more fixation devices. The holes 1608 may be used to connect a holding across the joint between the first cuneiform 210 and the first metatarsal 230 after compression.	164	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Next, the method 1700 proceeds and a preliminary cutting guide model is provided 1706 from a repository of template cutting guide models. A preliminary cutting guide model is a model of a preliminary cutting guide.	173	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	As used herein, "preliminary cutting guide" refers to a guide configured, designed, and/or engineered to serve as a template, prototype, archetype, or starting point for creating, generating, or fabricating a patient specific cutting guide. In one aspect, the preliminary cutting guide may be used, as-is, without any further changes, modifications, or adjustments and thus become a patient specific cutting guide. In another aspect, the preliminary cutting guide may be modified, adjusted, or configured to more specifically address the goals, objectives, or needs of a patient or a surgeon and by way of the modifications become a patient specific cutting guide. The patient specific cutting guide can be used by a user, such as a surgeon, to guide making one or more resections of a structure, such as a bone for a procedure. Accordingly, a preliminary cutting guide model can be used to generate a patient specific cutting guide model. The patient specific cutting guide model may be used in a surgical procedure to address, correct, or mitigate effects of the identified deformity and may be used to generate a patient specific cutting guide that can be used in a surgical procedure for the patient.	174	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In certain embodiments, the preliminary cutting guide model may be generated based on anatomic data and/or a bone model or a combination of these, and no model or predesigned structure, template, or prototype. Alternatively, or in addition, the preliminary cutting guide model may be, or may originate from, a template cutting guide model selected from a set of template cutting guide model. Each model in the set of template cutting guide models may include one or more cutting guide features positioned and/or sized and/or configured to fit for an average patient’s foot. The template cutting guide model may subsequently be modified or revised by an automated process or manual process to generate the preliminary cutting guide model used in this disclosure.	175	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Next, the method 1700 may register 1708 the preliminary cutting guide model with one or more bones of the bone model. This step 1708 facilitates customization and modification of the preliminary cutting guide model to generate a patient specific cutting guide model from which a patient specific cutting guide can be generated. The registration step 1708 combines two models and/or patient imaging data and positions both models for use in one system and/or in one model.	178	Added by DJM 2 2022	2/25/22, 12:00 AM

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