Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-12	Alternatively, or in addition, the bone engagement surface 2033 is configured to receive the surface of the bone, where the resection guide 2020a is to be placed. Specifically, a user, based on a prescription and/or in consultation with a surgeon, may determine a planned position for a resection guide 2020a on a lateral surface of a bone of the patient. The user may then reflect this planned position using a model of the bone of the patient and a model of the resection guide 2020a. Because the model of the bone of the patient is a highly accurate representation, the bone engagement surface 2033 defined on the medial side 2032 of the model of the resection guide 2020a accurately includes the features and aspects of the surface of the bone of the patient. Examples of features and aspects of a bone that the bone engagement surface 2033 can include, but are not limited to, a tuberosity, tubercle, crest, spine, process, trochanter, linea, fossa, foramen, notch, groove or sulcus, a protrusion, a projection, a tuberosity, a cavity, a void, a divot, a tab, an extension, a hook, a curve, or the like of the surface of the bone model, but in a reverse or inverse configuration. For example, where a cavity is on a surface of the bone model (and the bone of the patient) a protrusion exists on the bone engagement surface 2033 exists that fits into the cavity.	319	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, the bone engagement surface 2033 is configured to register to a lateral surface of a bone of a patient. In certain embodiments, the bone engagement surface 2033 is defined based, at least in part, on a lateral surface of a bone model of a bone of a patient’s foot. Advantageously, the bone engagement surface 2033 is a negative contoured surface that resembles, substantially resembles, and/or matches a surface of the bone model contacting a model of the resection guide 2020a, when the model of the resection guide 2020a is positioned as desired on the bone model. In one embodiment, registration of a bone engagement surface 2033 means that each feature or aspect of the bone engagement surface 2033 engages, mates, and/or fits within a corresponding feature or aspect of the surface of the bone of the patient. For example, where the bone surface includes a protrusion, the bone engagement surface 2033 includes a recess configured to accept and engage with that protrusion.	320	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	As mentioned herein, the bone model used to determine, or at least partially determine, the shape, size, and/or configuration of the bone engagement surface 2033 is based on medical imaging of at least a portion of the patient’s foot and is configured to resemble, significantly resemble, and/or match the anatomy of the patient’s foot.	321	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 21F is a medial side view of a resection guide 2020a.	322	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 21G is a lateral side view of a resection guide 2020a.	323	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 21H is a dorsal side view of a resection guide 2020a.	324	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 21I is a plantar side view of a resection guide 2020a.	325	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Figure 21J illustrates a cross section view of the resection guide 2020a positioned on a bone (e.g., a calcaneus) of a patient. A surgeon has created a first osteotomy using the posterior resection feature 2022a and a second osteotomy using the anterior resection feature 2022b.	326	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Referring now to Figures 21J, 21A, and 21B, in the illustrated embodiment, the posterior resection feature 2022a comprises an opening that starts on the lateral side 2030 and extends to the medial side 2032. The opening of the posterior resection feature 2022a extends through the body 2028 along a first trajectory 2042. In the illustrated embodiment, the anterior resection feature 2022b comprises an opening that starts on the lateral side 2030 and extends to the medial side 2032. The opening of the anterior resection feature 2022b extends through the body 2028 along a second trajectory 2044.	327	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The opening of the posterior resection feature 2022a and/or the opening of the anterior resection feature 2022b has a width and/or length large enough to accommodate, or accept, a cutting element of a cutting tool. In one embodiment, the opening of the posterior resection feature 2022a is configured to guide and/or enable a cutting tool to form a first osteotomy 2046 into, and/or through, the bone. Advantageously, the first osteotomy 2046 tracks, follows, and/or is aligned with the first trajectory 2042. In one embodiment, the opening of the anterior resection feature 2022b is configured to guide and/or enable a cutting tool to form a second osteotomy 2048 into, and/or through, the bone. Advantageously, the second osteotomy 2048 tracks, follows, and/or is aligned with the second trajectory 2044. Thus, a surgeon operating the cutting tool within the opening of the posterior resection feature 2022a and the anterior resection feature 2022b can readily form a first osteotomy 2046 and a second osteotomy 2048 that matches a design that may have been set out in a model of the resection guide 2020a and/or a model of the patient’s bone(s).	328	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, the first trajectory 2042 may be determined and/or defined to be a patient-specific feature. Similarly, the second trajectory 2044 may be determined and/or defined to be a patient-specific feature. Advantageously, using the apparatus, methods, and/or systems of the present disclosure a user may determine and/or at least partially determine the first trajectory 2042 and/or the second trajectory 2044 based on a bone model of at least a portion a bone of the patient that is to receive one or more osteotomies. The bone model of at least a portion of the bone can be derived from and/or based on medical imaging of a patient’s foot. In certain embodiments, the bone model used to determine, or at least partially determine, the first trajectory 2042 and/or the second trajectory 2044 is configured to resemble, substantially resemble, or match the anatomy of the patient’s foot.	329	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	As used herein, in certain embodiments, partial determination of the first trajectory 2042 and/or the second trajectory 2044 based on a bone model may mean that the bone model for the a bone of a patient that will receive the osteotomies is used together with other imaging data, anatomic data, patient imaging data, patient data, information from a prescription from a doctor, information about surgeon preferences, measurement data taken from the bone model or medical imaging, or the like may also be used to determine the first trajectory 2041 and/or the second trajectory 2044.	330	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, the posterior resection feature 2022a extends through the resection guide 2020 from the lateral side 2030 to the medial side 2032 along the first trajectory 2042. The first trajectory 2042 is at least partially determined based on a bone model of at least a portion of a bone of a patient’s foot. The bone model is based on medical imaging of the patient’s foot and is configured to resemble, significantly resemble, and/or match the anatomy of the patient’s foot. Alternatively, or in addition, the anterior resection feature 2022b extends through the resection guide 2020 from the lateral side 2030 to the medial side 2032 along the second trajectory 2044. The second trajectory 2044 is at least partially determined based on a bone model of at least a portion of a bone of a patient’s foot. The bone model is based on medical imaging of the patient’s foot and is configured to resemble, significantly resemble, and/or match the anatomy of the patient’s foot.	331	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Those of skill in the art will appreciate that the first trajectory 2042 and the second trajectory 2044 can define a path for the osteotomies formed using the posterior resection feature 2022a and/or anterior resection feature 2022b. Alternatively, or in addition, where a surgical procedure plans to perform a wedge osteotomy, the first trajectory 2042 and the second trajectory 2044 can predefine the size, shape, and configuration of a wedge fragment formed by the osteotomy.	332	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, a surgeon may desire to perform a wedge osteotomy. In this embodiment, the resection guide 2020a is designed such that the first trajectory 2042 converges with the second trajectory 2044 at a vertex 2102 having a wedge angle 2104, such that posterior resection feature 2022a and the anterior resection feature 2022b form a wedge osteotomy comprising a wedge bone fragment 2050 after formation of the first osteotomy 2046 and the second osteotomy 2048, the wedge angle 2104 determined based, at least in part, on the bone model 1204. Advantageously, the various aspects of the design of the resection guide 2020a and/or an accompanying surgical technique and/or complementary components 1930 can be done prior to fabrication of one or more components of the osteotomy system 2000. Thus, a surgeon can define or adjust the position of the vertex 2102, the number of degrees for the wedge angle 2104, a height 2106 of the body 2028, and the like. Of course, certain of these aspects may be predefined for a surgeon and/or recommendations made to a surgeon. Alternatively, or in addition, certain of these aspects may be patient-specific while others may be standard based on experience and/or established practice for a particular procedure.	333	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, a surgeon and/or a technician, working with the surgeon, may determine the size, shape, and/or configuration of a wedge bone fragment 2050 to be removed from the bone. Furthermore, a surgeon and/or a technician can determine whether to perform an osteotomy that forms a wedge bone fragment 2050 or an osteotomy that enables an opening wedge osteotomy or an osteotomy that does not include a wedge (closing or opening). The type of osteotomy to be performed can determine whether or not the first trajectory 2042 and/or second trajectory 2044 converge and/or the size of the posterior angle 2052 and/or anterior angle 2056.	334	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, a surgeon can also determine, preoperatively, whether the vertex 2102 will be inside the bone or outside the bone. For example, the surgeon may decide to have the vertex 2102 outside the bone a distance away from a medial surface 2108 of the bone (e.g., calcaneus 224). The position of the vertex 2102 may depend on the surgical procedure, surgeon preference, a surgeon’s planned correction, or the like. In such an embodiment, the first trajectory 2042 may converge with the second trajectory 2044 at a vertex 2102 outside the bone and spaced a distance from the medial cortex 2110 of the bone.	335	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In another instance, a surgeon may determine to have the vertex 2102 between the medial cortex 2110 of the bone and the resection guide 2020a when the resection guide 2020a is in use for a surgical procedure. Alternatively, or in addition, a surgeon may determine to have the vertex 2102 between a medial cortex 2110 of the bone and the resection guide 2020a when the resection guide 2020a is designed for a patient’s foot. In certain osteotomies, a surgeon may desire that the vertex 2102 is positioned within the bone and offset from the medial cortex 2110 by a predetermined offset 2112. Advantageously, using embodiments of the present disclosure a surgeon can determine and/or adjust the size of the predetermined offset 2112.	336	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	A surgeon may desired to position the vertex 2102 between the medial cortex 2110 of the bone and the resection guide 2020a when the resection guide 2020a is in use for a surgical procedure such that the first osteotomy 2046 and the second osteotomy 2048 leave bone between the vertex 2102 and the medial cortex 2110 intact. This intact bone may serve to keep a posterior bone fragment 2114 connected to an anterior bone fragment 2116. Depending on the surgical procedure planned, a surgeon may desire to keep this bone intact to serve as a “living hinge” which can be used to close the wedge osteotomy. Of course, different surgeons may have different sizes they want for predetermined offset 2112. Alternatively, or in addition, the size of the predetermined offset 2112 may be based at least in part on how the patient presents for the procedure or preparation and planning for the procedure.	337	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Advantageously, the present disclosure enables the thickness/size of the predetermined offset 2112 to be predetermined, to be patient-specific, as well as the determination of whether or not to have a predetermined offset 2112. As described, a surgeon may preposition the vertex 2102 to be within the bone or outside the bone.	338	Added by DJM Jan 2024	1/6/24, 10:03 PM

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