Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-12	Figure 24D illustrates a stage in the surgical osteotomy procedure (e.g., a Dwyer osteotomy) in which a wedge resection has been performed. The wedge bone fragment 2050 is not shown for clarity. The pin guides 2200 include the posterior pin 2220 and the anterior pin 2222 (because these pins serve to engage a posterior bone fragment 2114 and an anterior bone fragment 2116 of the calcaneus 1806 after the resection and/or for subsequent repositioning of the bone fragments of the calcaneus 1806.	417	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 24E illustrates a closer view of the stage in the surgical osteotomy procedure (e.g., a Dwyer osteotomy) of Figure 24D. Note that in certain embodiments, the wedge cut from the bone may not extend to the opposite side of the bone. Instead approximately a 1-3 mm section of bone can be left on the other side of the bone from the osteotomy. This section can facilitate handling of the bone fragments of the calcaneus 1806 during the surgical osteotomy procedure (e.g., a Dwyer osteotomy). In certain embodiments, this remaining portion can be used as a living hinge to keep the two bone fragments together during a fixation step or during one or more steps of the surgical osteotomy procedure. In one embodiment, for example where a surgeon plans to rotate one bone fragment in relation to the other, the method 2400 may further include breaking a medial cortex 2110 opposite a wedge bone fragment 2050. Now, with the bone fragments separated, a surgeon may translate a posterior pin 2220 within a posterior alignment feature 2306 of a positioning guide 2300 to rotate a posterior bone fragment 2114 to a position determined by a surgeon to remediate a condition of the patient’s foot. For example, a surgeon may seek to achieve rectus alignment for a patient's foot, this may include structural realignment of the calcaneus 1806 from a calcaneal varus or valgus deformity to a rectus alignment. The ability to translate and/or rotate the posterior bone fragment 2114 in relation to the anterior bone fragment 2116 enables such repositioning and correction.	418	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 24F illustrates a cross section view from an inferior side of the calcaneus 1806 looking upward. Figure 24F includes the resection guide 2020a of Figure 21D taken along a line along an anterior-posterior direction through the resection guide 2020a, a posterior pin guide 2202, anterior pin guide 2204, posterior pin 2220, and anterior pin 2222.	419	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 24F illustrates that the resection guide 2020a can be configured to resect a particular shape from the bone, such as a wedge shape. Furthermore, the resection guide 2020a can be configured to resect a shape specific and unique to a particular patient. Said another way, the dimensions of the wedge bone fragment 2050 can be patient-specific.	420	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Advantageously, resection features 2022 of the resection guide 2020a can be configured to enable a surgeon using a cutting tool to separate the resected bone (e.g., wedge bone fragment 2050) from the patient bone (e.g., calcaneus 1806) while leaving in a part of the bone on the medial side, the medial cortex 2110. Advantageously, bone attachment features 2024 can be positioned within a perimeter of the resection features 2022 of the resection guide 2020a. Having the bone attachment features 2024 within the perimeter of the of the lateral side of the resection guide 2020a can provide secure engagement of a resected part (e.g., a wedge bone fragment 2050) of the bone once resection is complete. This can facilitate removal and/or repositioning of the wedge bone fragment 2050. In addition, fasteners 2010 used together with the bone attachment features 2024 can extend perpendicular to a surface of the resection guide 2020a and/or parallel to each other which can then facilitate removal of the resection guide 2020a after forming one or more osteotomies. Alternatively, or in addition, bone attachment features 2024 within the perimeter of the lateral side of the resection guide 2020a can facilitate minimally invasive surgery (MIS) procedures because this positioning of the bone attachment features 2024 can enable the resection guide 2020 to be smaller in size.	421	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 24F illustrates that one or more resection features 2022 of the resection guide 2020a can be used to position additional fasteners that can be used later in an osteotomy procedure to reposition bone or bone parts of the patient (e.g., parts of the calcaneus 1806). In Figure 24F, a first osteotomy and a second osteotomy have been performed and a bone wedge fragment is connected to the one or more fasteners 2010 but separated from the calcaneus 1806.	422	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, an arm 2206 of a pin guide 2200 can be placed into a resection feature 2022 at a predefined position. The arm 2206 may extend at a predefined distance and/or angle such that a fastener 2010 inserted through a hole 2214 near one end of the arm 2206 will engage the bone (e.g. calcaneus 1806) or part of a bone at a desired position and/or angle. Advantageously, even though the fasteners 2010 may engage the bone, calcaneus 1806, at a variety of angles, the pin guides 2200 may be separate components such that they can be readily removed as the osteotomy procedure (e.g., wedge osteotomy procedure) proceeds to subsequent steps. Of course, in certain embodiments, the pin guides 2200 may be integrated with the resection guide 2020. Separate pin guides 2200 may be desirable to facilitate removal of the resection guide 2020 and/or pin guides 2200 during a procedure.	423	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, it may be desirable to position the fasteners 2010 within the pin guides 2200 and relative to each other such that the fasteners 2010 are aligned in an anterior to posterior direction. In this manner, the original position of the parts of the bone (e.g. calcaneus 1806) can be maintained and used for subsequent steps of the osteotomy procedure (e.g., wedge osteotomy procedure).	424	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	After the stage illustrated in Figure 24E, a surgeon may remove the posterior pin guide 2202, anterior pin guide 2204, and the resection guide 2020. (block 2414) Then, a surgeon may remove the wedge bone fragment 2050 using, for example, the one or more fasteners 2010. (block 2416) Then, a surgeon may slide a positioning guide 2300 over the posterior pin 2220 and the anterior pin 2222 until the positioning guide 2300 contacts the posterior bone fragment 2114 and the anterior bone fragment 2116. (block 2420) In certain embodiments, this action of sliding the positioning guide 2300 to contact bone fragments can cause the osteotomy to be reduced and/or can cause the bone fragments to be translated and/or rotated relative to each other.	425	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 24G illustrates a stage in the surgical osteotomy procedure (e.g., a Dwyer osteotomy) of Figure 24E. The resection guide 2020a and pin guides 2200 have been removed. The additional fasteners 2012 in the pin guides 2200 remain engaged with the calcaneus 1806. A positioning guide 2300 has been deployed. In certain embodiments, a medial cortex 2110 opposite the osteotomy may be broken by a surgeon (e.g., manually). Alternatively, or in addition, the resection guide 2020a can be configured to enable resection through the bone to the medial surface 2108 of the calcaneus 1806.	426	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, the positioning guide 2300 can facilitate translation and/or rotation of two parts of a bone or two bones of a patient. In the illustrated embodiment, the action of positioning guide 2300 on the fasteners 2012 can cause the posterior bone fragment 2114 to translate relative to the anterior bone fragment 2116. In certain embodiments, the positioning guide 2300 can include an offset feature (translation feature) that facilitates positioning the posterior bone fragment 2114 with a desired translation and/or orientation relative to the anterior bone fragment 2116. In addition, in certain embodiments, one or more of the pin guides 2200 (e.g., an anterior pin guide 2204 and a posterior pin guide 2202) may permit rotation of one part of the bone in relation to the other part or another landmark.	427	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	After the stage of an osteotomy procedure illustrated in Figure 24G, a surgeon may temporarily or permanently fixate the posterior bone fragment 2114 and the anterior bone fragment 2116. In one embodiment, a surgeon may deploy fixation across an osteotomy between the posterior bone fragment 2114 and the anterior bone fragment 2116.	428	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The surgeon may use a variety of fasteners including a staple, a plate, one or more K-wires for temporary fixation, or the like. In one embodiment, the posterior pin 2220 and/or anterior pin 2222 may be designed to provide pilot holes and/or anchor holes for one or more fasteners of a fixation assembly, device, system, or apparatus.	429	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Zadik osteotomy	430	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 25 illustrates an exemplary osteotomy system 2500 for a Zadik osteotomy, according to one embodiment. The osteotomy system 2500 can include two or more fasteners 2510 (2510a, 2510b), a resection guide 2520 (two embodiments 2520a, 2520b), and one or more complementary components 1930. While specific embodiments of complementary components 1930 are not specifically shown here in relation to the osteotomy system 2500, those of skill in the art will appreciate that complementary components 1930 similar in feature, purpose, design, implementation, configuration, and purpose as those described in relation to the wedge osteotomy system 2000 can be used for the osteotomy system 2500. Thus, the osteotomy system 2500 can include one or more alignment guides 1940, rotation guides 1950, correction guides 1960, compression guides 1970, positioning guides 1980, fixation guides 1990, one or more pin guides 1994, and/or implants 1996.	431	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figures 26A-26B illustrates different stages of performing a surgical osteotomy procedure (e.g., a Zadik osteotomy) using the osteotomy system of Figure 25, according to one embodiment. Typically, the preferred approach for a Zadik osteotomy is on the lateral side of the calcaneus 1806. Figure 26A illustrates the resection guide 2520b secured to the calcaneus 1806 by way of fasteners 2010.	432	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 26B illustrates a closer view of the stage in the surgical osteotomy procedure (e.g., a Zadik osteotomy) of Figure 26A with the resection guide 2520b positioned on a calcaneus 1806 of a foot. Figure 26B illustrates a stage in the surgical osteotomy procedure (e.g., a Zadik osteotomy) in which a wedge resection has been performed. Fasteners 2012 can serve to engage the proximal and distal parts of the calcaneus 1806 after the resection and/or for subsequent repositioning of the proximal and distal parts of the calcaneus 1806.	433	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Note that Figure 26B illustrates a wedge cut that extends to the opposite side of the bone. Alternatively, or in addition, in certain embodiments, instead of the wedge extending to the opposite side approximately a 1-3 mm section of bone may be left on the other side (medial side) of the bone. This section can facilitate handling of the parts of the calcaneus 1806 during the surgical osteotomy procedure (e.g., a Zadik osteotomy). In certain embodiments, the remaining portion can be used as a living hinge to keep the two parts of the bone together during a fixation step or during one or more steps of the surgical osteotomy procedure.	434	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figures 27A-27D illustrate views of a resection guide of an osteotomy system, according to one embodiment. The resection guide 2520 of osteotomy system 2500 can include some or all of the same or substantially the same features, aspects, and/or components as the resection guide 2020. Accordingly, the resection guide 2520 can or may include one or more resection features 2522 (e.g., resection features 2522a-c), one or more bone attachment features 2524 (e.g., bone attachment features 2524a-d), one or more handles 2526 (e.g., handles 2026a,b), one or more bone engagement surfaces 2530, and one or more landmark registration features 2528 (e.g., landmark registration feature 2528a,b). Similarly, features of the resection guide 2520 (e.g., resection features 2522, bone attachment features 2524, handles 2526, landmark registration features 2528, and bone engagement surfaces 2530) may be the same, similar, or substantially similar to those of the resection guide 1920 or resection guide 2020 described above. Of course the features of the resection guide 2520 may be configured to facilitate the particular osteotomy procedure (e.g., Zadik).	435	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, the resection features 2522 may be positioned and oriented such that resecting along the resection features 2522 will enable resection of a wedge shape from the bone. Advantageously, the resection features 2522 can be positioned and oriented such that the wedge enables a repositioning of parts of the bone in two or more planes (biplanar; e.g., sagittal and transverse). Of course, the resection features 2522 can also be positioned and oriented such that the resection cuts made are within a single plane, and may angle toward each other to form a wedge resection.	436	Added by DJM Jan 2024	1/6/24, 10:03 PM

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