Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-12	One challenge with osteotomies is how to maintain control over one or more bone fragments throughout the surgical procedure. Advantageously, the fastener 2010a and fastener 2010b connected or coupled to the anterior bone fragment 1806a and/or posterior bone fragment 1806b enable a surgeon to maintain control over these bone fragments. With the osteotomy completed, a surgeon can then focus on positioning and/or reorienting bone fragments to remediate a bone condition of the patient.	497	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The positioning guides 3810 (e.g., positioning guide 3810a and/or positioning guide 3810b) are configured to engage with fastener 2010a and fastener 2010b such that the bone fragments connected to the fasteners remain connected, stable, and positioned in a desired position, until a surgeon takes steps to change the position. This stability can be very helpful to a surgeon to achieve a desired positioning and desired eventual patient outcome. In one embodiment, with the positioning guide 3810b seated and the bone fragments translated and/or rotated, a surgeon can confirm that the bone fragments are in a desired position. This may be done using medical imaging such as flouroscopy. Advantageously, the osteotomy system 3800 (e.g., positioning guide 3810b and fasteners 2010a,b) retains the bone fragments in the same position prior to, during, and after capturing imaging using flouroscopy. This can be a great help to a surgeon as their hands are free during the flouroscopy check and they are assured that the bone fragments have not moved during the flouroscopy check. The surgeon can have confidence that bone fragments are in a desired position and will maintain that position until either repositioned and/or fixation is deployed to secure the bone fragments in place. Such reliability and assurance can greatly assist a surgeon because once fixation is deployed, repositioning of the bone fragments may be very challenging and may lead to less than desirable outcomes. Therefore, a surgeon may strive to ensure that the bone fragments are in a desired position and maintain that position up until permanent fixation is deployed. The embodiments of the present disclosure provide this advantage to the surgeon.	498	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 39E illustrates a stage in the surgical osteotomy procedure. The positioning guide 3810b is seated and in place and a fixation guide 3890 can been coupled to fastener 2010a and fastener 2010b. In one embodiment, the fixation guide 3890 includes openings that are slid over the fastener 2010a and fastener 2010b. In one embodiment, a posterior opening that receives fastener 2010b may be oversized and/or in a slot shape to account for different angles of rotation that a positioning guide 3810b may use in the osteotomy system 3800.	499	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In this manner, a surgeon may use one positioning guide 2300 initially, may then check the translation and/or alignment and/or results and may opt to change to another different positioning guide 2300, for example, one having a different offset feature 2308 and/or offset distance 2338. In this manner, a surgeon may try different positioning guides 2300 intraoperatively until a positioning guide 2300 is found that provides a desired amount of translation and/or rotation and/or reduction and/or compression for two bones and/or bone fragments of a patient.	396	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, the offset feature 2308 may be activated by sliding the positioning guide 2300 down along a posterior pin 2220 and an anterior pin 2222 until a medial side 2314 contacts a first bone fragment. Next, the positioning guide 2300 may be pressed against a bone and/or a pin may be pulled in an opposite direction from the direction the positioning guide 2300 is pressed until a second bone fragment engages the medial side 2314. In this manner, the offset feature 2308 can facilitate positioning of two bone fragments prior to fixation. In one embodiment, the offset feature 2308 is configured to translate a posterior bone fragment 2114 relative to an anterior bone fragment 2116. The posterior bone fragment 2114 and anterior bone fragment 2116 may be formed by way of a first osteotomy 2046 or a second osteotomy 2048.	397	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Advantageously, the offset feature 2308 can be designed prior to fabrication of the positioning guide 2300 and may include two offset surfaces of the medial side 2087. The amount of offset and/or configuration can be predefined and approved by a surgeon before fabrication of the positioning guide 2300. In one embodiment, the positioning guide 2300 may also include one or more drill guides for pilot holes or anchor holes for one or more fasteners of a fixation assembly. For example, holes extending from the lateral side 2086 to the medial side 2087 may be used for drill pilot holes and/or K-wires for deployment of bone screws and/or a bone plate.	398	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 24A is a flowchart of an example method 2400. In some implementations, one or more method steps of Figure 24A may be performed by a surgeon using one or more of the systems, apparatuses, and/or components described herein.	399	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	As shown in Figure 24A, method 2400 may include accessing a lateral surface of a calcaneus (block 2402). For example, a surgeon may access a lateral surface of a calcaneus, by using conventional surgical approaches to access the bone and/or to perform a periosteal elevation.	400	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	As also shown in Figure 24A, method 2400 may include positioning a resection guide onto the lateral surface of the calcaneus. The resection guide may include: a body having an anterior side, a posterior side, a medial side, a lateral side, a dorsal side, and a plantar side; a posterior resection feature configured to guide a cutting tool to form a first osteotomy in the calcaneus, the posterior resection feature extending through the resection guide from the lateral side to the plantar medial side along a first trajectory determined based on a calcaneus model of the calcaneus based on medical imaging of the patient’s foot, the calcaneus model configured to match the anatomy of the patient's foot; an anterior resection feature configured to guide a cutting tool to form a second osteotomy that connects with the first osteotomy to form a wedge bone fragment from the calcaneus, the anterior resection feature extending through the resection guide from the lateral side to the plantar medial side along a second trajectory determined based on the calcaneus model; a first bone attachment feature configured to engage the wedge bone fragment after formation of the wedge bone fragment; a second bone attachment feature configured to engage the wedge bone fragment after formation of the wedge bone fragment; a plantar landmark registration feature that extends from the plantar side of the body and is configured to contact a plantar surface of the calcaneus; and a bone engagement surface on the medial side of the body, the bone engagement surface configured to match a contour of the calcaneus when the body is positioned on the calcaneus (block 2404). For example, a surgeon may position a resection guide onto the lateral surface, the resection guide, as described herein.	401	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	As further shown in Figure 24A, method 2400 may include deploying a first fastener into the first bone attachment feature and a second fastener into the second bone attachment feature such that the first fastener and second fastener are parallel relative to each other and enter a portion of the calcaneus that will form the wedge bone fragment (block 2406). For example, a surgeon may deploy a first fastener into the first bone attachment feature and a second fastener into the second bone attachment feature such that the first fastener and second fastener are parallel relative to each other and enter a portion of the calcaneus that will form the wedge bone fragment, as described herein.	402	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	As also shown in Figure 24A, method 2400 may include inserting the cutting tool into the posterior resection feature to a depth predefined in a preoperative plan designed based on the calcaneus model to form the first osteotomy (block 2408). For example, a surgeon may insert the cutting tool into the posterior resection feature to a depth predefined in a preoperative plan designed based on the calcaneus model to form the first osteotomy, as described above.	403	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	As further shown in Figure 24A, method 2400 may include inserting the cutting tool into the anterior resection feature to a depth predefined in a preoperative plan designed based on the calcaneus model to form the second osteotomy, the second osteotomy forming a posterior bone fragment and an anterior bone fragment (block 2410). For example, a surgeon may insert the cutting tool into the anterior resection feature to a depth predefined in a preoperative plan designed based on the calcaneus model to form the second osteotomy, the second osteotomy forming a posterior bone fragment and an anterior bone fragment, as described herein.	404	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	As also shown in Figure 24A, method 2400 may include engaging a posterior pin guide with the posterior resection feature and deploying a posterior pin into a bone attachment feature of the posterior pin guide and engaging an anterior pin guide with the anterior resection feature and deploying an anterior pin into a bone attachment feature of the anterior pin guide (block 2412). For example, a surgeon may engage a posterior pin guide with the posterior resection feature and deploy a posterior pin into a bone attachment feature of the posterior pin guide and engage an anterior pin guide with the anterior resection feature and deploy an anterior pin into a bone attachment feature of the anterior pin guide, as described herein.	405	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	As further shown in Figure 24A, method 2400 may include removing the posterior pin guide and the anterior pin guide and the resection guide (block 2414). For example, a surgeon may remove the posterior pin guide and the anterior pin guide and the resection guide, as described herein.	406	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Alternatively, or in addition, the landmark registration feature 2041 can include a bone engagement surface 2043 that can further facilitate registration of the landmark registration feature 2041 and/or resection guide 2020a with the bone. In this manner, a surgeon can be assured intraoperatively that the resection guide 2020a is being positioned in accordance with a preoperative plan. In one embodiment, the bone engagement surface 2043 is fabricated based on a bone model of the bone the bone engagement surface 2043 is to engage. In certain embodiments, the bone engagement surface 2043 is shaped to accept a surface of a bone placed in contact with the resection guide 2020a. Alternatively, or in addition, the bone engagement surface 2043 of the landmark registration feature 2041 may be shaped to include a contour that resembles, substantially resembles, and/or matches a surface of a bone model of a bone that the resection guide 2020a is to be used with for a surgical procedure (e.g., a patient’s bone). The bone engagement surface 2043 may be formed with, a part of, and/or similar to the bone engagement surface 2033 of the resection guide 2020a.	313	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, the landmark registration feature 2041 can be shaped like a hook to engage a plantar/inferior surface of bone or a dorsal/superior surface of bone. Alternatively, or in addition, the resection guide 2020a may include a landmark registration feature 2041 on each end (inferior/plantar landmark registration feature 2041a and superior/dorsal landmark registration feature 2041b), together the landmark registration features 2041 can engage one or more landmarks of a surface of the bone such that the surgeon can accurately position and register the resection guide 2020a to the bone. Of course, a resection guide 2020a can include a plurality of landmark registration features 2041. In one embodiment, one or more landmark registration features 2041 can engage a plantar side of a calcaneus 224 and/or a dorsal side of the calcaneus 224.	314	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In the illustrated embodiment, a plantar landmark registration feature 2041a extends from the plantar side 2040. Advantageously, the landmark registration feature 2041 is configured to engage with one or more landmarks for bone of a patient. Advantageously, because the resection guide 2020a is defined in relation to one or more bones of a patient using a model of the one or more bones and a model of the resection guide 2020a, the size, shape, length and width of the landmark registration feature 2041 can be defined to facilitate engagement between the landmark registration feature 2041 and a landmark such as a dorsal surface of the bone. Furthermore, whether or not the resection guide 2020a includes a landmark registration feature 2041 may be a patient-specific feature.	315	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Like the body 2028, the plantar landmark registration feature 2041a and the handle 2026a may also include a medial side 2032, the body 2028 and the plantar landmark registration feature 2041a may both have the same medial side 2032. In one embodiment, the bone engagement surface 2033 may include the bone engagement surface 2043 (See Figures 21E, 21F). Said another way, the bone engagement surface 2033 may extend beyond the medial side 2032 of the body 2028 to include a medial side of the plantar landmark registration feature 2041a and the handle 2026a.	316	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, the posterior resection feature 2022a and anterior resection feature 2022b may extend from the lateral side 2030 to the medial side 2032. Advantageously, a depth of the posterior resection feature 2022a and/or anterior resection feature 2022b through the body 2028 is long enough to guide a cutting tool and keep the cutting tool oriented along a trajectory defined by an opening of the resection features 2022. Advantageously, the present disclosure enables a osteotomy system 2000 that assists a surgeon in managing a depth of an osteotomy in the bone.	317	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 21E illustrates a medial side 2032 perspective view of a resection guide 2020a. In the illustrated embodiment, the medial side 2032 includes a bone engagement surface 2033. In one embodiment, the bone engagement surface 2033 is configured to contact and/or engage with a surface of a bone of a patient. In one embodiment, periosteum on the bone is elevated and/or stripped around the area of the bone where the resection guide 2020a is to be positioned. The periosteal elevation exposes the bone surface for engagement by the bone engagement surface 2033. Advantageously, the bone engagement surface 2033 is configured to substantially conform to the surface of the bone. Alternatively, or in addition, the bone engagement surface 2033 is configured to partially conform to the surface of the bone.	318	Added by DJM Jan 2024	1/6/24, 10:03 PM

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