Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-24	FIG. 18 illustrates an exemplary ankle fusion osteotomy system 1800, according to one embodiment. In one embodiment, the exemplary ankle fusion osteotomy system 1800 is specifically designed for use on a lateral side of the patient’s ankle (e.g., using a lateral approach). Those of skill in the art will appreciate that the same or a similar exemplary ankle fusion osteotomy system 1800 can be used on a medial side of the patient’s ankle (e.g., using a medial approach). Those of skill in the art will also appreciate that a surgical procedure that conducts an ankle fusion on an ankle from a medial or lateral approach generally includes steps to perform an osteotomy on the malleolus (medial or lateral depending on the approach) and retracting or holding a distal end of the malleolus out of the way for the osteotomy steps on the tibia 226 and/or talus 222. Those of skill in the art will appreciate that the osteotomy system 1800 can include one or more components that are patient-specific and/or one or more components that are not patient-specific. Thus, the osteotomy system 1800 can be a combination of patient-specific components and/or non-patient-specific components.	368	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	The osteotomy system 1800 can include one or more fasteners 810 and/or two or more sets of fasteners (810a, 810b, 810c), one or more resection guides 1820, and zero or one or more complementary components 730. In the illustrated embodiment, the resection guides 1820 include a first resection guide 1822 and a second resection guide 1824. The resection guides 1820 may also include one or more of resection features 1826, bone attachment features 1828, bone engagement feature 1830, and/or landmark registration feature 1834. In certain embodiments, a bone engagement feature 1830 can include a bone engagement surface 1832.	369	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	While specific embodiments of complementary components 730 are not specifically shown here in relation to the osteotomy system 1800, those of skill in the art will appreciate that complementary components 730 can be similar in feature, design, implementation, configuration, and purpose as those described in relation to the osteotomy system 700 and can be used for the osteotomy system 1800. Thus, the osteotomy system 1800 can include one or more alignment guides 740, rotation guides 750, correction guides 760, compression guides 770, positioning guides 780, fixation guides 790, navigation guides 792, implants 794, or the like.	370	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Either or both of the resection guides 1820 may be custom patient-specific resection guides made for a particular patient and/or for a particular surgical procedure. Various aspects of the resection guides 1820 may be patient-specific, including, but not limited to, an angle and/or orientation for a resection feature of the resection guide 1820, a position of the resection feature, a depth of the resection feature, a size of the resection guide 1820, a configuration and/or composition of a bone contacting surface such as a bone engagement surface of the resection guide 1820, and the like.	371	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Either or both of the resection guides 1820 of osteotomy system 1800 can include some or all of the same or substantially the same features, aspects, alternatives, and/or components as other example resection guides described herein with like components including the same or similar reference numerals. Accordingly, the resection guide 1822 can or may include a first resection feature 1864, a second resection feature 1866, one or more bone attachment features 1828, one or more bone engagement features 1830, one or more alignment guides 1874, one or more shafts 1878, one or more openings 1876, one or more resection guards 1870 (not shown), one or more fastener guides 1890 (not shown), and the like. The bone engagement features 1830 may include one or more bone engagement surfaces 1832. Alternatively, or in addition, either or both of the resection guides 1820 can include one or more stabilizers 1892 and one or more sights 1894.	372	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	The resection guides 1822 may each include a body that includes an anterior side, a posterior side, a medial side, a lateral side, a superior side, and an inferior side. In certain embodiments, a first resection guide 1822 may be combined with a second resection guide 1824 into a single resection guide 1820.	373	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In one embodiment, the resection guides 1820 may differ from other resection guides described herein because the first resection feature 1864 and/or the second resection feature 1866 may differ from other example resection features described herein.	374	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In the illustrated embodiment, the first resection feature 1864 and the second resection feature 1866 are configured to form one or more osteotomies for a “dome” osteotomy. A dome osteotomy is a form of osteotomy that results in resected bone surface resembling or taking the shape of a dome or hemisphere. In the illustrated embodiment, the dome osteotomy can be accomplished by a resection feature that forms a curved osteotomy. In certain embodiments, a curved osteotomy can be a challenge for form using a cutting tool such as a reciprocating saw blade. However, where the cutting tool is a burr, a curved osteotomy is easier to form.	375	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In the illustrated embodiment, the first resection feature 1864 and second resection feature 1866 are configured to facilitate forming a curved osteotomy (and/or an angled curved osteotomy). Specifically, in one embodiment, the first resection feature 1864 and/or second resection feature 1866 may include a plurality of openings arranged in a curved pattern. Each of the openings may be sized to accept a cutting tool such as a burr. The burr drills a hole in bone opposite the opening. Alternatively, or in addition, the burr can be angled to resect bone between the openings. By forming bone tunnels or holes using the plurality of openings a surgeon can form a curved osteotomy (and/or an angled curved osteotomy) in the bone. Furthermore, angling the burr once in the bone can enable a surgeon to interconnect adjacent bone tunnels to complete the osteotomy.	376	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In another embodiment, a resection feature (e.g., first resection feature 1864 and/or second resection feature 1866) can be implemented by way of a slot that has a curve, or curved, shape. The resection feature may extend into a body of a resection guide 1820 from one side and out an opposite side and the resection feature includes a first end and a second end. The resection feature may have a curve or curved shape between the first end and the second end. Such a resection feature is referred to herein as a curved slot. In one embodiment, the curved slot may have a curved cross section similar to the curve shape illustrated in the example first resection feature 1864 and/or second resection feature 1866. In one embodiment, a surgeon may insert a cutting tool such as a burr into bone through a curved slot and follow a path between the first end and the second end of the curved slot to resect a curved osteotomy.	377	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Alternatively, or in addition, a single resection guide 1820 may include a pair of resection features. A first resection feature can include a plurality of openings in a curved shape with a few millimeters between them along the arc of the curve. A surgeon may first form holes in bone using each of the openings of the first resection feature. Next, a surgeon may replace the first resection feature with a second resection feature. The second resection feature may include a plurality of openings that are offset from the holes of the first resection feature. The offset holes enable a surgeon to form holes or tunnels in the bone that are adjacent to and may interconnect with the holes formed using the first resection feature. In this manner, a surgeon can accurately form a curved osteotomy (and/or an angled curved osteotomy) in the bone. In one embodiment, the first resection feature and second resection feature may be interchangeable by way of a coupler.	378	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Referring now to FIGs. 2E, 18, and 19A-G, a first resection guide 1822 includes a first resection feature 1864. The first resection feature 1864 is configured to guide a cutting tool for form a curved osteotomy. The curved osteotomy is curved when viewed and/or measured within a sagittal plane 262 of an ankle of a patient. In particular, the curved osteotomy is formed by a pattern of a plurality of openings arranged in a curve within the body of the first resection guide 1822. In the illustrated embodiment, the pattern is a downward curve shape. Where the first resection guide 1822 is used on a proximal end of a bone, this pattern results in a convex curve shape on the end of the bone resected using the first resection guide 1822.	379	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	The curved osteotomy is determined, at least partially, based on a bone model of at least a portion of the patient's ankle. The bone model is based on medical imaging of the patient's ankle. A curve osteotomy is an osteotomy that has a curve shape that starts on one end and includes at least one arc and ends at another end.	380	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In the illustrated embodiment, by forming a bone tunnel in the bone aligned with each of the plurality of openings in the first resection feature 1864, and then interconnecting the bone tunnels, a curved shape (like a dome) can be formed on an end or within a bone of a patient. The bone tunnels can be interconnected by angling a burr cutting tool within one opening in one direction and/or the other (e.g., medially and/or laterally). In one embodiment, the openings of the plurality of openings have a diameter that permits a burr cutting tool to be moved in a way to interconnect bone tunnels. Alternatively, or in addition, the bone tunnels can be interconnected by using an osteotome to remove walls between adjacent bone tunnels.	381	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Referring now to FIGs. 2E, 18, and 20A-G, in the illustrated embodiment, a second resection guide 1824 includes a second resection feature 1866. The second resection guide 1824 is configured to guide a cutting tool to form an angled curved osteotomy. The angled curved osteotomy is similar to a curved osteotomy in that the angled curved osteotomy is curved when viewed and/or measured within a sagittal plane 262 of an ankle of a patient.	382	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In addition, an angled curved osteotomy extends into a bone at an angle that is not perpendicular to a long axis (e.g., mechanical axis 880 of a bone). In the illustrated embodiment, the angled curved osteotomy may extend into a tibia at first angle 1896 that is not perpendicular to a long axis of the tibia 226 (e.g., mechanical axis 880 of the tibia 226). In one embodiment, the first angle 1896 is measured within a frontal plane 264. In particular, the first angle 1896 can be measured in relation to a horizontal medial-lateral axis ML within the frontal plane 264. In certain embodiments, the first angle 1896 can range from 1 degree to 88 degrees and can be extend from the ML axis in either a dorsal direction or a plantar direction.	383	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	The resection feature 826a may be used to make a primary resection of the talus 222. The resection feature 826b may be used to make a secondary, or additional resection, along a side of the talus 222 (e.g., a medial side of the talus 222). During the surgical procedure, a surgeon may resect within the resection feature 826b to remove medial parts of the talus 222 and/or parts of the medial malleolus (e.g., within a medial gutter between the tibia 226 and the talus 222) to facilitate a clean and accurate fit between the resected talus 222 and the resected tibia 226 during reduction and for the fusion.	282	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In certain embodiments, the resection feature 826a can be angled in a cephalad/dorsal direction or a caudal/plantar direction within the transverse plane 266. Alternatively, or in addition, the resection feature 826a can be angled in a cephalad/dorsal direction or a caudal/plantar direction within the sagittal plane 262. Alternatively, or in addition, the resection feature 826a can be positioned to resect the talus 222 normal to the transverse plane 266.	283	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Advantageously, a surgeon (e.g., end user) and/or fabricator of the resection guides 820 can predefine desired angles, locations, and sizes for any, each, or all of the resection features 826 of the resection guides 820. For example, size, angle, orientation, trajectory, and location for any of the resection feature 826 can be determined by way of the user instructions 604. In this manner, a surgeon can resect the tibia 226 and/or talus 222 in such a way that positions the talus 222 fore, aft, medial, or lateral within the joint when fused to correct a deformity.	284	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In addition, the ability to define resection features 826 preoperatively can enable a surgeon to resect one or more malleoli of a patient to achieve a desired surgical procedure outcome. For example, the resection guides 820 can be used to resect the malleoli of a patient such that translational/rotational correction in one joint or foot match another joint or foot or extremity more precisely.	285	Added by DJM Jan 2024	1/6/24, 10:01 PM

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