Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-20	In certain embodiments, the positioning guide 780 may be designed and fabricated to be patient-specific. The patient-specific aspects can include a patient-specific bone engagement surface, a predefined angle for reorienting one or more bone or bone parts within one or more planes, a predefined position for bone attachment features 724 or fasteners 710, a predefined or patient-specific offset or amount of translation that is provided, or the like. Alternatively, or in addition, the positioning guide 780 may be selected from a kit, collection, or repository of a number of positioning guides 780: each having a different configuration for one or more aspects/attributes of the positioning guide 780. For example, each member of the repository/kit may include a different positioning angle (repositioning or correction angle), the angles may differ by 2 degrees for example. In such an embodiment, each positioning guide 780 may not be patient-specific to a particular patient but may provide the desired amount of positioning to meet the goals of the surgeon. In certain embodiments, a preoperative plan generated based on the present disclosure may include a recommendation for the positioning guide 780 to be used, even if the recommended positioning guide 780 is not patient-specific to the particular patient.	199	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	A fixation guide 790 can help a surgeon in completing one or more temporary or permanent fixation steps for one or more bones, parts of bones, or other parts of a patient as part of a procedure. The fixation guide 790 may include and/or may use one or more components of a fastener or fixation system including implant hardware of the fastener or fixation system.	200	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Those of skill in the art will appreciate that the other complementary components 730 may each have functions, purposes, and/or advantages with respect to one or more anatomical parts of the patient. Alternatively, or in addition, the other complementary components 730 may each have functions, purposes, and/or advantages with respect to one or more instruments and/or one or more anatomical parts of the patient. For example, a trajectory guide may be a type of alignment guide 740 in that the trajectory guide facilitates alignment of fixation with the desired location and/or trajectory/orientation with respect to one or more anatomical parts of the patient. Alternatively, or in addition, a trajectory guide may also be considered a type of fixation guide 790 because the trajectory guide facilitates deployment of one or more fasteners 710.	201	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Advantageously, the system 700 can help a surgeon overcome one or more of the challenges in performing an osteotomy procedure, particularly on bones of a hand or of a foot of a patient, such as on the forefoot, midfoot, or hindfoot. One challenge during an osteotomy procedure can be maintaining control of, and/or position, and/or orientation of a bone, one or more bones, and/or bone pieces/fragments, particularly once a resection or dissection is performed. Advantageously, the fasteners 710, resection guide(s) 720, and/or complementary components 730 can be configured to assist in overcoming this challenge.	202	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Advantageously, system 700 can help a surgeon in positioning, placing, and/or orienting a resection guide accurately. Modern techniques may include preoperative planning, simulation, or even practice using computer models, 3D printed models, virtual reality systems, augmented reality systems or the like. However, simulations and models are still different from actually positioning a resection guide on a patient’s bone, joint, or body part during the procedure. System 700 can include a number of features, including patient-specific features, to assist the surgeon with the positioning. In one embodiment, the resection guide 720 can include one or more landmark registration features 728.	203	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Advantageously, the system 700 can help a surgeon in securing guides of the osteotomy system 700, such as a resection guide, as well as how to readily remove the guide (e.g., resection guide) without disturbing a reduction, shifting, reorienting, or repositioning one or more bones or parts of bones while removing the guide. In certain embodiments, the system 700 is configured to permit removal of a guide while keeping temporary fasteners in place for use in subsequent steps of an osteotomy procedure. Alternatively, or in addition, system 700 may facilitate positioning of temporary fasteners during one step of a wedge osteotomy procedure for use in a subsequent step of the wedge osteotomy procedure. Removal of a guide during an osteotomy procedure can be particularly challenging where translation and/or rotation of the bones involved in the osteotomy procedure is required for the success of the osteotomy procedure. Advantageously, system 700 accommodates translation and/or rotation of the bones during the osteotomy procedure while facilitating a successful outcome for the osteotomy procedure.	204	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Advantageously, the components of the system 700 can be specifically designed for a particular patient. Alternatively, or in addition, the components of the system 700 can be specifically designed for a class of patients. Each of the components of system 700 can be designed, adapted, engineered and/or manufactured such that each feature, attribute, or aspect of the component is specifically designed to address one or more specific indications present in a patient. Advantageously, the cuts made for the osteotomy procedure can be of a size, position, orientation, and/or angle that provides for an optimal osteotomy with minimal risk of undesirable resection. In one embodiment, the components of system 700 can be configured such that an osteotomy is performed that enables a correction in more than one plane in relation to the parts of the body of the patient. For example, cut channels or resection features 722 in a resection guide 720 can be oriented and configured such that when the bones are fused/fixated the correction results from translation, rotation, and/or movement of bones or bone parts in two or more planes (e.g., sagittal and transverse) once the fragments or bones are reduced.	205	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In certain embodiments, the exemplary system 700 may include a plurality of fasteners 710, resection guides 720, and/or complementary components 730. For example, a surgeon may plan to resect a plurality of osteotomies from the bone(s) in order to accomplish a desired correction. In one example, one or more wedge segments may be resected from a medial side of a patient's foot and another one or more wedge segments may be resected from a lateral side of the patient's foot. These wedge segments may extend part way into the foot, or through from one side of the foot to the other. Of course, multiple wedge segments may be formed on one side of the foot as well.	206	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Additionally, a surgeon may use one or more components in an exemplary system 700 to make multiple cuts in the bone(s). The multiple cuts may be centered over or around an apex of a deformity or positioned at other locations within the foot such that when the multiple cuts are made, any resected segments removed, or added bone void fillers introduced, and/or bones and/or bone fragments translated and/or rotated the combined angles, surfaces, removed segments, and/or added portions cooperate to provide a desired correction. Each of the components of the exemplary system 700 can be identified, defined, and reviewed using the apparatuses, systems, and/or methods of the present disclosure.	207	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In certain embodiments, the components of system 700 may be made as small as possible to minimize the amount of soft tissue that is opened in the patient for the osteotomy procedure. Alternatively, or in addition, walls and/or sides of the components may be beveled and/or angled to avoid contact with other hard tissue or soft tissues in the operating field for the osteotomy procedure.	208	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Those of skill in the art will appreciate that for certain osteotomy procedures a complementary component 730 may not be needed or a given complementary component 730 may be optional for use in the osteotomy procedure. Similarly, those of skill in the art will appreciate that certain features of the fasteners 710, resection guides 720, and/or complementary components 730 can be combined into one or more of apparatus or devices or may be provided using a plurality of separate devices.	209	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	FIG. 8 illustrates an exemplary system 800 for an osteotomy, according to one embodiment. Those of skill in the art will appreciate that embodiments of the present disclosure may be used for a through cut osteotomy, a wedge osteotomy, one or more osteotomies for an arthrodesis, or the like. An osteotomy using the exemplary system 800 can enable reorientation of the metatarsal to a more desired configuration or orientation, in some instances. In addition, the system 800 can be designed to address a desired degree of rotation of a bone of the patient using the instrumentation of the system 800. For example, certain instruments can be designed and fabricated to enable or facilitate rotation of a first metatarsal 208 about its long axis after an osteotomy in order to move sesamoids 258 to a more plantar facing orientation. Advantageously, because the amount of rotation can be determined prior to a surgical procedure, this amount of rotation can also be adjusted and revised before instrumentation is fabricated and/or a preoperative plan is completed. Alternatively, or in addition, accommodations can be made for using instruments that may permit a surgeon to use different instruments during surgery that enables the surgeon to adapt as they learn how much movement or adjustment soft tissue around a surgical site will permit. For example, a surgeon may include a plurality of the resection guides that can be interchanged during surgery to meet the needs of the patient and/or the surgeon.	210	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	The system 800 may include one or more fasteners 918, a resection guide (a proximal resection guide 820a and distal resection guide 820b), and one or more other complementary components 830, such as a navigation guide 840 (two embodiments are illustrated navigation guide 840a and navigation guide 840b; which may also serve as a pin positioning guide 840), and a positioning guide 880. Advantageously, the apparatus, system, and/or methods of the present disclosure enable the surgeon and/or patient to preplan each aspect of the surgical procedure. For example, which fasteners 918, which style and configuration of resection guide 820a,b, which navigation guide 840 and/or which positioning guide 880 will be used, can all be decided before the surgical procedure is scheduled.	211	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In the illustrated embodiment, system 800 includes one or more guide pins, pins, or k-wires 918a, one or more staples 918b, one or more bone screws (not shown), and one or more bone plates 918c. Certain fasteners 918 may be used for temporary fixation while others may be used for permanent fixation. In one embodiment, the fasteners 918 are configured to single use. In one embodiment, the fasteners 918 may be provided in a surgical kit and a surgeon may choose which fasteners to use during the procedure. Alternatively, or in addition, the precision and accuracy of the present disclosure may enable a surgeon to select specific fasteners 918 to use as part of planning the surgical procedure. For example, a surgeon may choose a specific size and configuration of bone plate(s) 918c to be used.	212	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In the illustrated embodiment, two separate resection guides, a proximal resection guide 820a and a distal resection guide 820b may be used. While those of skill in the art will appreciate that a single resection guide 820 can be used for an osteotomy of a cuneiform and a metatarsal, using two separate resection guides can provide certain advantages. As mentioned herein, modeling of hard tissue is highly accurate and precise while modeling of soft tissue is less predictable. Consequently, a surgeon may not know with sufficient certainty how soft tissue will respond to steps of a surgical procedure. Specifically, the surgeon may not know now much translation and/or rotation of tissues such as bones the soft tissue will permit until the surgeon is performing the surgery.	213	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Advantageously, using two separate resection guides can enable a surgeon to adapt intraoperatively to the amount of rotation and/or translation the soft tissue will permit. Specifically, one resection guide may include a resection feature with a first angle for correction, a second resection guide may include a resection feature with a second angle for correction greater than the first, a third resection guide may include a resection feature with a third angle for correction greater than the second, and so forth. These different resection guides may be part of a kit available to the surgeon during the surgery. In this manner, a surgeon can choose a resection guide with a preferred angle for correction during the surgery.	214	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In certain embodiments, both a proximal resection guide 820a and a distal resection guide 820b can include a resection feature that is angled at an angle that is not 90 degrees with respect to a long axis of the bone being cut. Alternatively, or in addition, only one of the resection guides 820 may include a resection feature that is angled at an angle that is not 90 degrees with respect to a long axis of the bone being cut and the other resection guide 820 may include a resection feature that is angled at an angle that is 90 degrees with respect to a long axis of the bone being cut. In certain embodiments, using a resection guide 820 with a resection feature that is angled 90 degrees relative to a long axis of the bone being cut can enable a surgeon to make an easier osteotomy of a bone using the resection guide 820. In addition, in certain embodiments, the osteotomy may be more precise and more accurate than using a resection guide 820 with a resection feature that is not angled 90 degrees relative to a long axis of the bone being cut.	215	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Either or both of the resection guides 820 may be a custom patient-specific resection guides made for a particular patient and/or for a particular surgical procedure. Various aspects of the resection guides 820 may be patient-specific, including, but not limited to, an angle and/or orientation for a resection feature of the resection guide 820, a position of the resection feature, a depth of the resection feature, a size of the resection guide 820, a configuration and/or composition of a bone contacting surface such as a bone engagement surface of the resection guide 820, and the like.	216	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	In the illustrated embodiment, the resection guides 620 are for one or more osteotomies at a TMT joint between a metatarsal and a cuneiform. The system 800 illustrates alternative embodiments of different components to show that each part of the system 800 can be custom designed based on the needs of the patient, the type of surgical procedure, and/or the preferences of the surgeon. Advantageously, in certain embodiments, practically every aspect of the features, aspects, and/or attributes of the system 800 can be specified and/or ordered.	217	Added by DJM Jan 2024	1/6/24, 10:06 PM
View Edit Delete	PER-20	Different aspects and/or embodiments of the components of the system 800 are described in more detail herein. In one embodiment, the system 800 includes a set of proximal guide pins 918a, a set of distal guide pins 918a, a navigation guide 840, a proximal resection guide 820a, a distal resection guide 820b, and a positioning guide 880.	218	Added by DJM Jan 2024	1/6/24, 10:06 PM

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