Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-24	In the illustrated embodiment, the resection feature 826a extends in a plantar direction away from a medial-lateral axis 882 at an angle A measured in degrees. The angle A may range from 1 degree to 60 degrees. A surgeon may designate and/or revise the magnitude of angle A, until the result of the osteotomies using angle A will provide a desired level of correction as determined by the surgeon. In certain embodiments, the osteotomy system 800 may include a proposed magnitude for angle A, that a surgeon can then revise as needed or desired.	286	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In the illustrated embodiment, the resection feature 826a may extend at angle A in relation to the medial-lateral axis 882 and guide a cutting tool perpendicular to a mechanical axis 880 of the tibia 226. The medial-lateral axis 882 runs in the transverse plane 266 perpendicular to the mechanical axis 880 of the tibia 226.	287	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Once a first osteotomy is performed using resection feature 826 of the tibial resection guide 822 and a second osteotomy is performed using the resection feature 826 (e.g., 826a, 826b) of the talus resection guide 824, a surgeon can then reduce the osteotomies. When a surgeon reduces the osteotomies and abuts the first osteotomy against the second osteotomy, the reduced osteotomies remediate a deformity of the patient. The tibia 226 and talus 222 can now fuse to complete the arthrodesis. It should be noted that in the illustrated embodiment the position, alignment, orientation, and/or trajectories for the resection features 826 are selected for an arthrodesis, no implants will be used between the first osteotomy and the second osteotomy.	288	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	FIG. 12B illustrates a resection interface 884 (see dashed oval). Prior to the osteotomies, the resection interface 884 can include a distal end of the tibia 226 and a proximal end of the talus 222. Once the osteotomies are performed, the resection interface 884 can include the resected surfaces on the distal end of the tibia 226 and a proximal end of the talus 22. Once the osteotomies are reduced, the resection interface 884 includes the resected surfaces abutting each other. Those of skill in the art will appreciate that for a given arthrodesis, ankle fusion procedure, the configuration of the osteotomies can be varied based on the experience level and/or desires of the surgeon in order to accomplish a successful fusion. Furthermore, the space between osteotomies and other structures of the ankle that a surgeon desires to preserve can be limited and thus require extra care. Advantageously, the present disclosure includes aspects to assist with accomplishing the desired osteotomies and preserving the surrounding structures. In one embodiment, these aspects can include one or more resection guards 870 and/or one or more stops. In certain embodiments, a resection guard 870 can serve as a stop.	289	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In certain embodiments, the osteotomy system 800 may include one or more resection guards 870. A resection guard 870 is a structure, device, part, component, or apparatus designed and/or positioned to mitigate or prevent resection beyond a particular point or boundary. The resection guard 870 can and/or does help a surgeon limit resection within a certain area of the bone as guided by a resection feature 826 and resection guard 870. In the illustrated embodiment, fasteners 810 may cooperate with the resection features 826 and/or openings in the resection features 826 to serve as both fasteners and as resection guards 870. Alternatively, or in addition, other structures may be used to serve as resection guards 870. In one embodiment, the fasteners 810 and/or resection guards 870 can be strategically positioned in the resection guides 820 and/or configured (e.g., having a particular length) such that the fasteners 810 and/or resection guards 870 also retain or retract soft tissue around an opening formed for performing the osteotomy.	290	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Advantageously, the resection guards 870 provide a boundary within the respective bones to prevent a cutting tool from drifting, or moving, outside an area defined by a resection feature 826. Resection of the talus 222 and/or tibia 226 can require deep cuts and keeping the cutting tool within the area defined by the resection feature 826 can be a challenge as the resection extends deeper and deeper into a bone. Advantageously, the resection guards 870 can assist the surgeon to avoid inadvertent resection of structures near or adjacent to the area indicated by the resection feature 826 (e.g., medial malleolus, lateral malleolus, etc.). In this manner, resection guards 870 can be a form of stop used in the osteotomy system 800.	291	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	As an osteotomy is performed in the resection feature 826 a surgeon may have limited to no information about how deep the osteotomy is extending into the bone. Of course, a surgeon can check depth using medical imaging such as fluoroscopy, however this can add time and expense to a procedure. In one embodiment, a preoperative plan included in the osteotomy system 800 can identify the width and length of cutting tool, such as a saw for a surgeon to use for each of the osteotomies. The saw may include laser etch depth markings on the blade such that as the blade enters a surgeon can read the depth from the blade. Alternatively, or in addition, the present disclosure can provide one or more stops to assist a surgeon in managing depth of the osteotomy.	292	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Based on the surgical procedure to be performed, many decisions about the design and/or make up of the patient-specific osteotomy system 606 can be made as recommendations and/or proposals by a technician to a surgeon. These decisions can be based in whole or in part on the surgical procedure to be performed, the bone model 404 and/or the user instructions 604.	201	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	For example, suppose a surgeon would like a patient-specific osteotomy system 606 for an ankle fusion procedure. One goal of the ankle fusion procedure may be to relieve pain of the patient and to remove a minimal amount of bone in the process of completing the procedure. In such an example, the bone model 404 may be of one or more bones of a foot and/or ankle of the patient. The surgeon may provide a request and/or a set of user instructions 604 for a patient-specific osteotomy system 606 for this ankle fusion procedure.	202	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Those of skill in the art will appreciate that the user instructions 604 may be of a variety of different types, lengths, number of details and may be provided in a variety of different formats including oral, written, or the like. In one embodiment, the user instructions 604 may be a request for a patient-specific osteotomy system 606 that includes a set of default instruments, preoperative plan, implants, or the like. For example, the user instructions 604 may as short and simple as “Please provide an osteotomy system for an ankle fusion of the left ankle for patient <<identifying information (e.g., name, dob, etc.)>> with an anterior approach.” The user instructions 604 may be provided in the form of a product order, a purchase order, a prescription, or the like. The user instructions 604 may be provided in written manual / analog form, include a manual signature, digital form, include an e-signature, or the like. In addition, the user instructions 604 may include security and/or authorization features that enable the receiver to confirm that the user instructions 604 are valid and are authorized by a particular surgeon or doctor. The user instructions 604 may indicate the approach to the surgical site (e.g., an ankle or foot joint or bone) the surgeon wants to take, anterior, posterior, medial, lateral, or the like.	203	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In another embodiment, the user instructions 604 may include specific instructions for the number and/or kind or type of components in the patient-specific osteotomy system 606 and/or the configuration of one or more of these components. For example, the user instructions 604 may identify a specific fixation product or fixation system the surgeon will be using for permanent fixation of the osteotom(ies). Alternatively, or in addition, the user instructions 604 may include designation of one or more complementary components and/or configurations for these components to be included in the patient-specific osteotomy system 606.	204	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In one embodiment, the user instructions 604 may designate a particular material and/or mass for fabricating one or more guides to be included in the patient-specific osteotomy system 606. Some surgeons may find that patient-specific instruments, such as a patient-specific resection guide may more readily register to one or more bone surfaces if the instrument has a greater mass and/or weight. With the greater mass and a sufficient fidelity bone engagement surface, a patient-specific instrument may seem to find its own way or seek out a desired position on a bone that matches or substantially matches a position planned when the patient-specific osteotomy system 606 was developed. Consequently, a surgeon may request in the user instructions 604 that the instrument be made from a metal such as titanium.	205	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	With the bone model 404 and user instructions 604 a user such as a technician may operate the design module 650 alone or together with other modules of the apparatus 602 to develop a patient-specific osteotomy system 606. In certain embodiments, a single user operates the apparatus 602. Alternatively, or in addition, a plurality of users, which may include an end user, such as surgeon can operate or interact with one or more modules of the apparatus 602 as the patient-specific osteotomy system 606 is designed or developed.	206	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In one embodiment, a technician may provide a patient-specific osteotomy system 606 that includes one or more complementary components and one or more resection guides, which may be patient-specific. The technician may also provide a preoperative plan. These may be provided to an end user (e.g., surgeon) either directly or by accessing the apparatus 602 remotely. The end user may review the preoperative plan and/or the components of the patient-specific osteotomy system 606 (e.g., resection guides) and may approve of the patient-specific osteotomy system 606 or may request changes. In certain embodiments, these changes may include the addition of one or more added bone engagement features, one or more resection guides, a change in a trajectory for a bone attachment feature, a change in trajectory for an osteotomy, an addition of openings in a guide to coincide with openings needed for a fixation system, as well as a plurality of other possible changes to the patient-specific osteotomy system 606. The technician may then make the requested changes and present a revised patient-specific osteotomy system 606 for the surgeon to review again. Next, the surgeon may approve of the revised patient-specific osteotomy system 606 and/or request additional changes.	207	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In the illustrated embodiment, the design module 650 may include a plurality of resection features 652 and/or a plurality of bone engagement features 654. A technician may select one or more resection features 652 and/or one or more bone engagement features 654 and include them in the patient-specific osteotomy system 606. Alternatively, or in addition, a surgeon may designate which resection features 652 and/or bone engagement features 654 to include in the patient-specific osteotomy system 606.	208	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In certain embodiments, the surgeon and technician may collaborate and/or consult with each other regarding the design and/or configuration of the patient-specific osteotomy system 606 and its components. The technician may share with the surgeon information about the technological features and/or limitations of the components of the patient-specific osteotomy system 606 and use the technician’s experience and know-how to make recommendations to the surgeon. The surgeon can present ideas and/or requests regarding what the surgeon would like for components of the patient-specific osteotomy system 606 and the technician can determine whether those ideas/requests can be satisfied using a patient-specific osteotomy system 606.	209	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	The apparatus 602 uses both the bone model 404 and user instructions 604 to provide a patient-specific osteotomy system 606. Advantageously, the apparatus 602 enables a surgeon to be involved in the design and development of a patient-specific osteotomy system 606 that is suited not just for the patient, but also for the needs, skills and/or preferences of the surgeon. In this manner, a patient-specific osteotomy system 606 can be provided that improves patient care and accomplishing of desired outcomes.	210	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In one embodiment, the operation of the design module 650 may be completely automated, partially automated, or completely manual. A user may control how automated or manual the designing of the patient-specific osteotomy system 606 is, including patient-specific instrument models, patient-specific instruments, and/or other components of the patient-specific osteotomy system 606.	211	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	The apparatus 602 may include a selection module 660 and an export / fabrication module 670. The selection module 660 facilitates the selection and/or customization of one or more complementary components for a patient-specific osteotomy system 606. Complementary components are described herein, but can include certain guides or other aids to facilitate completing a surgical procedure as planned. In one embodiment, the operation of the selection module 660 may be completely automated, partially automated, or completely manual. A user may control how automated or manual the selection module 660 is.	212	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	The export / fabrication module 670 is configured to enable exporting of a patient-specific osteotomy system 606 for a variety of purposes including, but not limited to, fabrication/manufacture of one or more patient-specific instruments and/or fixator(s), ordering or fabricating one or more members of the patient-specific osteotomy system 606, generation of a preoperative plan, generation of a physical bone model matching the bone model 404, and the like.	213	Added by DJM Jan 2024	1/6/24, 10:01 PM

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