Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-12	Figures 23A-23G illustrate views of a positioning guide 2300 of an osteotomy system, according to one embodiment. In one embodiment, the positioning guide 2300 includes a body 2302, an anterior alignment feature 2304, and a posterior alignment feature 2306. In another embodiment, the positioning guide 2300 includes the body 2302, the anterior alignment feature 2304, the posterior alignment feature 2306, and an offset feature 2308. In another embodiment, the positioning guide 2300 includes the body 2302, the anterior alignment feature 2304, the posterior alignment feature 2306, the offset feature 2308, and a bone engagement surface 2310.	379	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The body 2302 may include a lateral side 2312, a medial side 2314, a posterior side 2316, an anterior side 2318, a dorsal side 2320, and a plantar side 2322. Figures 23A-23H illustrate different views of one embodiment of a positioning guide 2300 and the sides of the body 2302.	380	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The posterior alignment feature 2306 and/or anterior alignment feature 2304 assist a surgeon in aligning and/or positioning and/or orienting a first bone fragment (e.g., posterior bone fragment 2114) and a second bone fragment (e.g., anterior bone fragment 2116). In one embodiment, the surgeon seeks to reduce an osteotomy and bring the first bone fragment and second bone fragment in contact with each other to encourage the two bone fragments to grow together and heal an osteotomy closed. The posterior alignment feature 2306 and/or anterior alignment feature 2304 give a surgeon a secure, reliable, and stable tool to control and/or manipulate the bone fragments, which now may be mostly separated (but for a living hinge, opposite segment of cortical bone) or completely separated.	381	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, the posterior alignment feature 2306 may include the posterior pin 2220 and the anterior alignment feature 2304 may include the anterior pin 2222. Together with the posterior pin 2220 and the anterior pin 2222, the posterior alignment feature 2306 and/or anterior alignment feature 2304 give a surgeon “handles” for translating and/or rotating the bone fragments. In another embodiment, the posterior alignment feature 2306 is independent of the posterior pin 2220 and the anterior alignment feature 2304 is independent of the anterior pin 2222.	382	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In the illustrated embodiment, the posterior alignment feature 2306 may be embodied as a slot 2324 that includes a dorsal end 2326, a plantar end 2328, and a length 2330 between the dorsal end 2326 and the plantar end 2328. The slot 2324 may be configured to receive a posterior pin 2220.	383	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, the length 2330 is patient-specific and may be determined prior to fabricating the positioning guide 2300. In one embodiment, the length 2330 is a predetermined length based on a bone model (e.g., a model of a calcaneus 224). The predetermined length may be set or defined to permit a user such as a surgeon to rotate a first bone fragment (e.g., posterior bone fragment 2114) relative to a second bone fragment (e.g., anterior bone fragment 2116). In certain embodiments, a prescription may include a number of degrees of rotation a surgeon desires for a posterior bone fragment 2114 and a system or apparatus may translate that number of degrees into the predetermined length for the length 2330.	384	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The anterior alignment feature 2304 may be embodied as a hole 2332 or opening that extends from the lateral side 2312 to the medial side 2314.	385	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, the slot 2324 and/or the hole 2332 may extend through the body 2302 perpendicular to a planar surface of the lateral side 2312. Alternatively, or in addition, one or the other, or both of the slot 2324 and/or the hole 2332 may extend through the body 2302 at an angle that is not perpendicular to a planar surface of the lateral side 2312. Advantageously, the embodiments of the present disclosure enable a user or surgeon to specifically design the positioning guide 2300 with a desired angle relationship for the slot 2324 and/or the hole 2332 through the body 2302.	386	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	During use of the positioning guide 2300, a surgeon may slide the slot 2324 over the posterior pin 2220 and the anterior pin 2222 over the hole 2332. As the positioning guide 2300 slides down the pins (e.g., posterior pin 2220 and anterior pin 2222) the distance between the slot 2324 and the hole 2332 longitudinally may reduce the osteotomy and bring the two bone fragments into contact with each other. Initially, the posterior pin 2220 may be near the dorsal end 2326. A surgeon can then move the posterior pin 2220 toward the plantar end 2328 to rotate the bone fragment engaged by the posterior pin 2220 about its longitudinal axis. The surgeon determines whether the posterior pin 2220 should be moved to near the plantar end 2328, remain near the dorsal end 2326, or some position in between. With the bone fragments connected to the posterior pin 2220 and/or the anterior pin 2222 translated, reduced, and/or rotated, surgeon can then connect the two bone fragments using temporary or permanent fixation hardware and/or techniques. In such an example, a surgeon can predefine (e.g., the length 2330 and/or the slot 2324) how much rotation is desired and/or adjust the amount of rotation intraoperatively to achieve a desired orientation during the surgery.	387	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In another embodiment, the anterior alignment feature 2304 may include a slot 2324 and the posterior alignment feature 2306 may include a hole 2332. Alternatively, or in addition, both the anterior alignment feature 2304 and the posterior alignment feature 2306 may each include slot 2324. Alternatively, or in addition, both the anterior alignment feature 2304 and the posterior alignment feature 2306 may each include hole 2332.	388	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Referring to Figures 23B, 23G, and 23H, in one embodiment, a positioning guide 2300 may include a bone engagement surface 2310. The bone engagement surface 2310 may be on the medial side 2314 of the body 2302. The bone engagement surface 2310 may be configured to register to a lateral surface of the posterior bone fragment 2114 and the anterior bone fragment 2116. In certain embodiments, this can mean that the bone engagement surface 2310 contacts and/or engages with the lateral surface of the bone fragments. In particular, recesses of the bone engagement surface 2310 engage with protrusions on the lateral surface and protrusions of the bone engagement surface 2310 engage with recesses on the lateral surface.	389	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In the illustrated embodiment, the positioning guide 2300 serves to reduce the osteotomy and bring two bone fragments together for fixation and eventual fusion. Accordingly, the bone engagement surface 2310 can be configured to account for a portion of each of the bone fragments (e.g., posterior bone fragment 2114 and anterior bone fragment 2116) after one or more of these bone fragments has been translated and/or rotated to a position below the positioning guide 2300. Advantageously, in certain embodiments, the bone engagement surface 2310 can be defined, at least in part, based a lateral surface of a one or more bone models of bones involved in a surgical procedure. In addition, the bone engagement surface 2310 can be defined, at least in part, based on a planned reduced position of a posterior bone fragment 2114 and/or an anterior bone fragment 2116. The planned reduced position may represent a desired final position of the bone fragment prior to fixation. Advantageously, the bone engagement surface 2310 is configured to resemble, substantially resemble, and/or match the surface of the bone fragments in this condition. In certain embodiments, the bone engagement surface 2310 may engage the lateral surface of the bone fragments such that a surgeon can “feel” the positioning guide 2300 register into place and “feel” that the positioning guide 2300 is in the position planned before the surgical procedure.	390	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	For example, suppose the bone is a calcaneus 224 and the surgical procedure and/or surgeon plans to retain the position of that anterior bone fragment 2116 and to translate and/or rotate the posterior bone fragment 2114 to correct a deformity. For example, a surgeon may perform the osteotomy of the calcaneus 224 to correct a varus deformity of the calcaneus 224. Consequently, the surgeon can plan to perform a superolateral (upward and lateral) translation of the posterior bone fragment 2114. Alternatively, or in addition, the surgeon may plan to rotate the posterior bone fragment 2114 to address a bone condition of the patient. Advantageously, the osteotomy system 2000 enables a surgeon to preplan the procedure and visualize how the procedure can address the condition. Furthermore, a surgeon can define a bone engagement surface 2310 for the positioning guide 2300 that will engage with the surfaces of the posterior bone fragment 2114 and/or the anterior bone fragment 2116 which will confirm intraoperatively that the bone fragments are in the predefined positions relative to each other. Advantageously, the bone engagement surface 2310 is defined, at least in part, based a lateral surface of a calcaneus model of the calcaneus 224. In addition, the bone engagement surface 2310 is defined, at least in part, based on a planned reduced position of the posterior bone fragment 2114 and/or the anterior bone fragment 2116.	391	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, where, for example, the positioning guide 2300 includes an offset feature 2308, the bone engagement surface 2310 may include a posterior surface 2334 and an anterior surface 2336. The posterior surface 2334 is configured to engage a surface of a posterior bone fragment 2114 and the anterior surface 2336 is configured to engage a surface of an anterior bone fragment 2116. Advantageously, one or both of the posterior surface 2334 and/or anterior surface 2336 can be configured to include a contour that resembles, substantially resembles, and/or matches a contour of a lateral surface of a posterior bone fragment 2114 and/or anterior bone fragment 2116 after one or the other or both of the bone fragments (e.g., posterior bone fragment 2114 and/or anterior bone fragment 2116) are positioned in preparation for fixation of the bone fragments.	392	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Referring to Figures 23C, 23D, 23E, and 23H, in certain embodiments, the positioning guide 2300 includes an offset feature 2308. The offset feature 2308 may also be referred to as a translation feature. The offset feature 2308 may be a structure that translates on bone or bone fragment in relation to another. In one embodiment, the offset feature 2308 can be used to translate a posterior bone fragment 2114 in relation to an anterior bone fragment 2116. Those of skill in the art will appreciate that the offset feature 2308 may drive one bone fragment in one direction while the other bone fragment remains stationary, may pull one bone fragment in one direction while the other bone fragment remains stationary, may pull one bone fragment in one direction while driving the other bone fragment in another direction, may drive one bone fragment in one direction while driving the other bone fragment in another direction, may drive both bone fragments in the same direction, or the like.	393	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In one embodiment, the offset feature 2308 may include an offset distance 2338. The offset distance 2338 may determine how much translation is provided between two bone fragments. In one embodiment, the offset distance 2338 can range from about 0 millimeters (i.e., no translation) to about 10 millimeters. Advantageously, the magnitude of the offset distance 2338 can be set using a model of one or more bones of the patient and/or a model of the positioning guide 2300. In this manner, the offset feature 2308 and/or the offset distance 2338 can be a patient-specific feature that can be defined based, at least in part on a model of a bone of a patient. A surgeon, or other user, can define the offset distance 2338 based on a desired about of translation.	394	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Alternatively, or in addition, a plurality of positioning guide 2300 (either with or without a bone engagement surface 2310, which may also be patient-specific or may not be patient-specific) may be fabricated and provided to a surgeon for possible use during a surgical procedure. The plurality of positioning guides 2300 may be provided in a kit. In one embodiment, each positioning guide 2300 in the kit may include a standard and/or default offset distance 2338. For example, the offset distance 2338 may vary by 5 millimeters between positioning guides 2300 in the kit.	395	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	The application module 1606 may apply the contour to the provided preliminary cutting guide model 1238 to custom contour a bone apposition surface of the preliminary cutting guide model 1238 to match the shapes of the medial cuneiform 202 and/or the first metatarsal 208. Applying the contour to the preliminary cutting guide model 1238 may convert the preliminary cutting guide model 1238 to a patient specific cutting guide model 1602.	252	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	Generation of the contours of the cuneiform apposition portion 326 and the metatarsal apposition portion 328 of the preliminary cutting guide model 1238 may be performed relative easily in various CAD programs. In some embodiments, the shapes of the corresponding surfaces of the medial cuneiform 202 and the first metatarsal 208 may be obtained directly from the bone model 1204, anatomic data 1212, CAD models and/or CT scan data, and simply copied onto the preliminary cutting guide model 1238. Various operations may be used to copy surfaces from one object to another. Additionally or alternatively, various Boolean operations, such as a Boolean subtraction operation, may be used to remove material from a model for the body 310 of the preliminary cutting guide model 1238 with a shape that matches the surfaces of the medial cuneiform 202 and the first metatarsal 208.	253	Added by DJM Jan 2024	1/6/24, 10:03 PM
View Edit Delete	PER-12	In certain embodiments, the design module 1250 may include an optional module, such as a modification module 1608. The modification module 1608 may enable a user such as a technician or surgeon to make additional modifications to the design and configuration of the preliminary cutting guide model 1238. In one embodiment, the user can change any of the features, angles, configurations, or parameters of the preliminary cutting guide model 1238. For example, a surgeon may be aware of other concerns or anatomic deformities of a patient, for example on an opposite foot or in connection with a hip or other orthopedic joint which motivate the surgeon to adjust an angle of one of more resection features of the preliminary cutting guide model 1238.	254	Added by DJM Jan 2024	1/6/24, 10:03 PM

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