Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	KBR-1 1400.2.623	In one embodiment, the change orientation mode module 550 may be configured to maintain one or more frequency metrics for a particular trigger event 506 or set of trigger events 506 that result in a change of the orientation mode from a current orientation mode to a different orientation mode. The trigger event 506 tracked using frequency metrics may be internal trigger events 506a and/or external trigger events 506b. "Metric" refers to any unit of measure for a particular quantity, trait, attribute, feature, and/or aspect. A metric can include any unit or system of measure based on the type of metric that is tracked, recorded, monitored, or measured. A metric can be measured in whole numbers, decimal numbers, fractions, or the like. In certain embodiments, the term metric may be used with an adjective that identifies the metric being tracked, recorded, monitored, or measured. For example, a "frequency metric" may refer to metric for a frequency of an event, action, and/or condition, or the like.	123	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	KBR-1 1400.2.623	In certain embodiments, before the navigation module 510 changes an association between an orientation mode and a context, the navigation module 510 may prompt the user for confirmation that the user wants to change the association between the context and an orientation mode to the orientation mode indicated by the user input. "Confirmation" refers to a form of user input that communicates agreement of a user with the information, assertion, or plan presented to the user. The user may provide the confirmation or decline to provide the confirmation, and the navigation module 510 may respond accordingly.	122	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	KBR-1 1400.2.623	For example, the change orientation mode module 550 may instruct the orientation mode module 530 to change the association between the orientation mode and the context, such that the orientation mode associated with the context is the orientation mode indicated by the user input. In response, the change orientation mode module 550 may update a repository record that records the association between the and the orientation mode to be the orientation mode indicated by the user input. Consequently, the orientation mode used the next time the user navigates in the context is the orientation mode to be the orientation mode indicated by the user input. "Association" refers to a relationship between one set of data or one object and another set of data, indicator, or object. In certain examples, an association can relate to pieces of data. The association can be defined by or captured using another indicator, a link, a tag, and/or a structural relationship between a first set of data and a second set of data.	121	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Referring to FIGS. 20 and 23, in the illustrated embodiments, the proximal alignment feature 1980/2280 and distal alignment feature 1990/2290 may be in separate devices rather than being combined in a single device. FIGS. 20 and 23 show the proximal alignment feature 1980/2280 as part of the cutting guide 1900/2200. FIG. 24A illustrates a distal alignment feature 1990/2290 that is part of a separate device. FIG. 24A illustrates a perspective view of the first cuneiform and the first metatarsal of FIGS. 20, 23 with one embodiment of a pin guide 2400 that includes a distal alignment feature 1990/2290.	275	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Accordingly, the cutting guide 2200 includes one or more bone attachment features. As embodied in Figures 22A through 22H, the bone attachment features may take the form of one or more holes 2250 that extend from the inferior side 2222 to the superior side 2220 and/or one or more fixation devices. The holes 2250 may be shaped to accommodate pins, K-wires, and/or other elongated bone fixation elements that can be anchored in the first cuneiform 210 and/or the first metatarsal 230 to keep the cutting guide 2200 in place.	263	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 23 illustrates one example of a cutting guide 2200 coupled to the bones using a proximal bone attachment feature 2252 and a distal bone attachment feature 2254. In the illustrated embodiment, the proximal bone attachment feature 2252 includes at least one hole 2250 and a fastener and the distal bone attachment feature 2254 includes at least one hole 2250 and a fastener. In FIG. 23 the fasteners are K-wires. Advantageously, the proximal bone attachment feature 2252 and the distal bone attachment feature 2254 each include at least two holes 2250, each with a K-wire passing through the hole 2250 and into bone facing the inferior side 2222. Using two holes 2250 and two fasteners ensures a stable coupling between the cutting guide 2200 and the bone(s). Advantageously, in certain embodiments, the two holes 2250 of the proximal bone attachment feature 2252 and distal bone attachment feature 2254 are align such that inserted K-wires are parallel to each other. Among other benefits, parallel K-wires of each of the proximal bone attachment feature 2252 and distal bone attachment feature 2254 prevent the cutting guide 2200 from pivoting around one of the K-wires of a proximal bone attachment feature 2252 or a distal bone attachment feature 2254.	264	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In the illustrated embodiment, the proximal arm 2230 includes the proximal bone attachment feature 2252 and the distal arm 2240 includes the distal bone attachment feature 2254. In one embodiment, the holes 2250 of the proximal bone attachment feature 2252 are aligned with each other and aligned perpendicular to a guide feature such as the second slot 2270 (see reference line 1992). The holes 2250 of the distal bone attachment feature 2254 may also be aligned with each other and aligned perpendicular to another guide feature such as the first slot 2260 (see reference line 1994). This means that the aligned holes 2250 (and K-wires secured within them) of the distal bone attachment feature 2254 will also be perpendicular to the cut surface formed using the first slot 2260. This also means that the aligned holes 2250 (and K-wires secured within them) of the proximal bone attachment feature 2252 will also be perpendicular to the cut surface formed using the second slot 2270. Consequently, at least one of the proximal bone attachment feature 2252 and the distal bone attachment feature 2254 can be used to position and orient a cut surface of the first metatarsal 230 and a cut surface of the first cuneiform 210. In certain embodiments, the proximal bone attachment feature 2252 and distal bone attachment feature 2254 may not be aligned with each other, the offset in the alignment may be the change in orientation of the bones of the joint desired to address the condition. It should be noted that the distal bone attachment feature 2254 may be parallel to the longitudinal axis 2276. In this manner, the distal bone attachment feature 2254 can be used as a reference for positioning a distal alignment feature 2290 on the first metatarsal 230.	265	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Returning to Figures 22A through 20, the body 2210 may further have features that facilitate desired translation and orientation of the first metatarsal 230 and/or first cuneiform 210 in order to fuse or join the two bones to complete the procedure. For example, in the illustrated embodiment, the cutting guide 2200 may include at least one alignment feature. A second alignment feature may be integrated into the cutting guide 2200 or the second alignment feature may be a separate feature from the cutting guide 2200.	266	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	In the illustrated embodiment, the proximal bone attachment feature 2252 serves as both a bone attachment feature and as an alignment feature, e.g., proximal alignment feature 2280. In this manner, the proximal bone attachment feature 2252 can provide both a bone attachment feature and an alignment feature in a single feature. In situations where a second bone of a joint, such as a first metatarsal 230, does not need to be rotated, translated, and/or re-oriented to mitigate a patient’s condition, the distal bone attachment feature 2254 may also serve as both a bone attachment feature and as an alignment feature, e.g., distal alignment feature 2290.	267	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Typically, in an osteotomy for a condition such as a hallux valgus, it is desirable to rotate the first metatarsal 230 to address the condition. The first metatarsal 230 may be rotated for example to re-position distal plantar sesamoids from a lateral orientation to a more plantar orientation. Research has shown that performing such re-orientation mitigates recurrence of a hallux valgus condition. In such situations, the distal bone attachment feature 2254 may serve as a bone attachment feature and as a reference for the positioning of a distal alignment feature 2290 that is separate from the cutting guide 2200.	268	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	For example, in such instances, the distal bone attachment feature 2254 may serve as a reference for placement of a distal alignment feature 2290 (See FIG. 24A) that is parallel to the distal bone attachment feature 2254 as measured along the longitudinal axis 2276 of the first metatarsal 230. Subsequent to formation of a cut surface on the first metatarsal 230, the distal alignment feature 2290 can be coupled to the first metatarsal 230 in parallel to the distal bone attachment feature 2254 (e.g., by way of a pin guide). In certain embodiments, the distal alignment feature 2290 can include two or more aligned holes and/or a pair of K-wires that enter the bone in parallel to each other. In addition, in such a situation, the proximal alignment feature 2280 and the distal alignment feature 2290 may not be aligned initially. Instead, the proximal alignment feature 2280 and distal alignment feature 2290 may be configured to align when the bone coupled to the distal alignment feature 2290 is rotated.	269	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 23 illustrates an example cutting guide 2200 seated transverse to a tarsometatarsal (“TMT”) joint 2000. The TMT joint 2000 includes a lateral end 2002 and a medial end 2004. In certain embodiments, such as the illustrated embodiment, the body 2210 is configured to extend between the lateral end 2002 and the medial end 2004. In this manner, the first slot 2260 and second slot 2270 extend along the TMT joint 2000 in a lateral medial direction and are long enough that a surgeon can readily resect the respective ends of the respective bones of the joint. In addition, the proximal arm 2230 and the distal arm 2240 may be aligned with each other. In one embodiment, the proximal arm 2230 and distal arm 2240 may extend proximal to the lateral side 2218 and/or proximal to the lateral end 2002 of the joint (e.g., TMT joint 2000).	270	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Advantageously, the cutting guide 2200 can be used with patients that have smaller bones and joints such as children or female patients. The cutting guide 2200 fits directly on the dorsal surfaces of the bones of the joint. This placement can avoid contact with soft tissues that may run along the medial and/or lateral surfaces of the bones of the joint.	271	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 23 illustrates that the cutting guide 2200 can be secured to the bones using the proximal bone attachment feature 2252 and/or distal bone attachment feature 2254 each of which may include two or more fasteners 1956. In certain embodiments, the fasteners 1956 of the proximal bone attachment feature 2252 are aligned with each other and perpendicular to the second slot 2270. The fasteners 1956 of the distal bone attachment feature 2254 are aligned with each other and perpendicular to the first slot 2260. The fit of the bone engagement surface 2224 to the surfaces (dorsal in this embodiment) of the bones helps to secure the cutting guide 2200 in place and ensure that resection of the bones using the first slot 2260 and second slot 2270 forms the desired cut surfaces for the procedure.	272	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Those of skill in the art will appreciate that in various embodiments certain aspects may interface with one or more dorsal surfaces of each or both of the bones of a joint. The illustrated embodiments provide at least one example. In other embodiments, at least one of a cutting guide body, a proximal arm, a distal arm, and a bone engagement surface of a inferior surface of the body is configured to engage a dorsal surface of one or more of a first bone and a second bone.	273	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	It should be noted that the cutting guide 1900 and/or cutting guide 2200 may be configured to engage with a dorsal surface of one bone (e.g., a first cuneiform 210) and a lateral surface of a second bone (e.g., a first metatarsal 230) of a joint (e.g., TMT joint 2000). For example, where the patient has a hallux valgus condition, the first metatarsal 230 may have rotated about its longitudinal axis 1976/2276 such that the lateral surface of the first metatarsal 230 faces dorsal. Advantageously, the present disclosure accounts for this and the cutting guide 1900/2200 is configured to contact a dorsal surface on one bone and a lateral surface of the second bone (or proximal surface if the bone is rotated in the other direction). Furthermore, the proximal alignment feature 1980/2280 may engage with a dorsal surface of a proximal bone and the distal alignment feature 1990/2290 may engage with a dorsal surface of a distal bone, even though the distal bone has rotated.	274	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	Referring to FIGS. 22H and 23, in one embodiment, the body 2210, or one or more arms, may include one or more bone attachment features that facilitate attachment of the body 2210 to the first cuneiform 210 and/or first metatarsal 230. Such bone attachment features may include any of a wide variety of fasteners including, but not limited to, holes, spikes, fastening devices, and/or the like. Effective connection of the cutting guide 2200 to one or more bones across a joint can ensure that cut surfaces are formed in desired locations and orientation and mitigate removal of hard tissue and/or soft tissue outside in undesired locations.	262	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	FIG. 24A illustrates a perspective view of the first cuneiform 210 and the first metatarsal 230 of FIG. 23 after resection of the bones. After resection, a surgeon remove the cutting guide 1900/2200 by sliding it off of the fasteners 1956 and keep the fasteners 1956 connected to the bones. The fasteners 1956 on the first cuneiform 210 can serve as a proximal alignment feature 1980/2280. The fasteners 1956 on the first metatarsal 230 can serve as a guide for a distal alignment feature 1990/2290. For example, the surgeon can slide pin guide 2400 over the fasteners 1956 on the first metatarsal 230. The pin guide 2400 can then identify where to position the distal alignment feature 1990/2290.	276	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The pin guide 2400 includes a bone attachment feature 2410 realized by a pair of holes 2412 that extend from a superior surface to an inferior surface. Advantageously, the holes 2412 can engage with the fasteners 1956 (which have remained in the bone) used with the cutting guide 1900/2200.	277	Added by DJM 2 2022	2/25/22, 12:00 AM
View Edit Delete	PER-10	The pin guide 2400 also includes a distal alignment feature 1990/2290. In certain embodiments, the distal alignment feature 1990/2290 is offset from the bone attachment feature 2410. In certain embodiments, the bone attachment feature 2410 is offset from the bone attachment feature 2410 by a certain distance that corresponds to a number of degrees of rotation of the first metatarsal 230 from an original position to a new positioned after rotating the first metatarsal 230 about its longitudinal axis 1976/2276. The first metatarsal 230 can be rotated a certain number of degrees about its longitudinal axis 1976/2276 in either a clockwise or a counterclockwise direction. Typically, the first metatarsal 230 is rotated counterclockwise to address a condition such as a hallux valgus condition.	278	Added by DJM 2 2022	2/25/22, 12:00 AM

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