Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-24	In one embodiment, the exemplary ankle fusion osteotomy system 800 may include one or more drill guides for pilot or anchor holes for one or more fasteners of a fixation assembly. For example, holes extending from the anterior side 852 to the posterior side 854 may be used for drill pilot holes and/or K-wires for deployment of bone screws and/or a bone plate.	274	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	FIGs. 12A-12C illustrate different views a surgical osteotomy procedure using the osteotomy system of FIG. 8, according to one embodiment.	275	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	FIGS. 12A illustrates a stage of performing a surgical osteotomy procedure (e.g., tibia and/or talus osteotomy and/or ankle fusion) using the osteotomy system 800, according to one embodiment. The exemplary ankle fusion osteotomy system 800 can be used to perform osteotomies for a surgical procedure that includes one or more of a fusion of a joint (e.g., arthrodesis), joint replacement, such as a total ankle replacement, and/or correction of a deformity. A surgeon may elect to approach the osteotomies on the anterior side of the foot. FIG. 12A illustrates a left foot and shows a lateral perspective view and an anterior-posterior axis 888. FIG. 12A illustrates two resection guides 820 (e.g., tibial resection guide 822 and talus resection guide 824) one secured to the talus 222 and one secured to the tibia 226 by way of one or more bone attachment features 828 which may be implemented, at least in part, using fasteners 810 and/or one or more holes or openings in the tibial resection guide 822 and talus resection guide 824.	276	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	FIG. 12B illustrates a close up anterior view of the talus resection guide 824 and tibial resection guide 822 positioned on the talus 222 and the tibia 226 of the left foot. Other foot bones are not shown for clarity. The talus resection guide 824 and/or tibial resection guide 822 may each include one or more resection features 826. The resection features 826 may serve similar, or the same, purposes as the resection features 722 and/or other resection features described herein. The resection features 826 guide a cutting tool in performing an osteotomy. Advantageously, as with other embodiments described herein, the number, size, configuration, length, width, position, and/or angle in one or more planes of the resection features 826 can be defined for a particular patient or for a group of patients and can be included in the tibial resection guide 822 and/or resection guard 870 provided for a surgical procedure.	277	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	The bone attachment features 828 secure the resection guide 820 to the bone for performing an osteotomy. Advantageously, as with other embodiments described herein, the number, size, configuration, length, width, position, and/or angle in one or more planes of the bone attachment features 828 can be defined for a particular patient or group of patients. In certain embodiments, one or more of the bone attachment features 828 (e.g., bone attachment features 828a, b, c, d) may be configured to enter the bone at predefined angles such that the pins, K-wires, or fasteners used as part of the bone attachment features 828 diverge, converge, or are parallel to each other as they extend into the bone.	278	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	FIG. 12B illustrates that the bone attachment features 828 of the tibial resection guide 822 may be angled such that the fasteners diverge as they extend into the tibia 226. This divergence can be advantageous since it can provide a stable engagement between the resection guide 820 and the bone. Similarly, converging bone attachment features 828 as they extend into the bone can also provide stable engagement of the bone. Alternatively, or in addition, divergence and/or convergence of one or more bone attachment features 828 can minimize the number of one or more bone attachment features 828 used for a surgical procedure. This can save time and materials. In the illustrated embodiment, bone attachment feature 828a may be angled medially and bone attachment feature 828b may be angled laterally. In another embodiment, bone attachment feature 828a may be angled to enter the bone perpendicular to surface and bone attachment feature 828b may be angled to converge with bone attachment feature 828a (either outside or within the bone). Advantageously, a surgeon can request certain configurations and/or trajectories for the bone attachment features 828 (e.g., by way of the user instructions 604).	279	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 talus resection guide 824 and/or the tibial resection guide 822 may include more or fewer bone attachment features 828 than those included in the illustrated embodiments. For example, in one embodiment, the talus resection guide 824 may include one or more additional bone attachment features 828 near a medial side 856 and/or near resection feature 826b. In certain embodiments, the number of bone attachment features 828 may be determined at least in part by user instructions 604.	280	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In the illustrated embodiment, the talus resection guide 824 includes two resection features 826 (resection feature 826a, resection feature 826b). Those of skill in the art will appreciate that a single resection feature 826 can be used instead of two or more resection features 826. In one embodiment, the resection feature 826b can assist a surgeon in resecting hard and/or soft tissue on a medial side of the joint. Such resection can contribute to a successful surgical procedure. In one embodiment, such resection may create clearance on the talus 222 for the talus 222 to fit under a medial malleolus when fused to the tibia 226. In certain embodiments, a resection feature 826 can be included on the lateral side of the talus resection guide 824. Similarly, additional resection features 826 can be used on the tibial resection guide 822 as well.	281	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In certain embodiments, the patient-specific instrument or instrument can be used to preposition and/or facilitate pre-drilling holes for a plate system for fixation purposes. Such plate systems may be optimally placed, per a CT scan, after a correction procedure for optimal fixation outcome. In another embodiment, the CAD model and/or automated process such as advanced computer analysis, machine learning and automated/artificial intelligence may be used to measure a depth of the a through a patient-specific resection guide for use with robotics apparatus and/or systems which would control the depth of each cut within the guide to protect vital structures below or adjacent to a bone being cut. In another embodiment, the CAD model and/or automated process such as advanced computer analysis, machine learning and automated/artificial intelligence may be used to define desired fastener (e.g. bone screw) length and/or trajectories through a patient-specific instrument and/or implant. The details for such lengths, trajectories, and components can be detailed in a report provided to the surgeon preparing to perform a procedure.	138	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	FIG. 1B is a flowchart diagram depicting a method 120 for correcting or remediating a bone condition, according to one embodiment. The method 120 may be used to prepare for an orthopedic procedure which corrects or remediates a bone, muscle, deformity, and/or tendon condition of a patient.	139	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	As shown, the method 120 may begin with a step 122 in which a CT scan (or another three-dimensional image) of the patient’s foot is obtained. The step 122 may include capturing a scan of select bones of a patient or may include capturing additional anatomic information, such as the entire foot. Additionally or alternatively, the step 122 may include receipt of previously captured image data. Capture of the entire foot in the step 122 may facilitate proper alignment of the first metatarsal with the rest of the foot (for example, with the second metatarsal). Performance of the step 122 may result in generation of a three-dimensional model of the patient’s foot, or three-dimensional surface points that can be used to construct such a three-dimensional model.	140	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	After the step 122 has been carried out, the method 120 may proceed to a step 124 in which a CAD model of the relevant portion of the patient’s anatomy is generated. The CAD model may optionally include the bones of the entire foot, like the CT scan obtained in the step 122. In alternative embodiments, the step 124 may be omitted in favor of direct utilization of the CT scan data, as described in connection with the step 104.	141	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In a step 126, the CAD model and/or CT scan data may be used to model patient-specific instrumentation that can be used to correct or remediate a bone condition. Such instrumentation may include a guide. In one example, the guide can seat or abut or contact a surface of a bone and including an opening that guides a trajectory for a fastener for a procedure. In some embodiments, performance of the step 126 may include modelling the guide with a bone engagement surface that is shaped to match contours of the surfaces of the bone, such that the bone engagement surface can lie directly on the corresponding contours of the bone.	142	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In a step 128, the model(s) may be used to manufacture patient-specific instrumentation and/or instruments. This may include manufacturing an instrument with the bone engagement surface and/or other features as described above. As in the step 108, the step 128 may additionally or alternatively involve provision of one or more instruments and/or implants from among a plurality of predetermined configurations or sizes. Further, the step 128 may additionally, or alternatively, involve provision of instructions for placement and/or anchorage of one or more instruments and/or instruments to carry out the procedure.	143	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	In a step 130, the manufactured instrument may be used in surgery to facilitate treatment of the condition. In certain embodiments, a bone engagement surface of the instrument may be placed against the corresponding contours of the bone. The instrument may include an opening and/or trajectory guide to guide insertion of a trajectory guide such as a temporary fastener such as a K-wire. The instrument may then be removed, and the remaining steps of a surgical procedure performed.	144	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	Method 100 and method 120 are merely exemplary. Those of skill in the art will recognize that various steps of the method 100 and the method 120 may be reordered, omitted, and/or supplemented with additional steps not specifically shown or described herein.	145	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	As mentioned previously, the method 120 is one species of the method 100; the present disclosure encompasses many different procedures, performed with respect to many different bones and/or joints of the body. Exemplary steps and instrumentation for the method 120 will further be shown and described in connection with the present disclosure. Those of skill in the art will recognize that the method 120 may be used in connection with different instruments; likewise, the instruments of the present disclosure may be used in connection with methods different from the method 100 and the method 120.	146	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	FIG. 2A is a perspective dorsal view of a foot 200. The foot 200 may have a medial cuneiform 202, an intermediate cuneiform 204, lateral cuneiform 206, a first metatarsal 208, a second metatarsal 210, third metatarsal 212, fourth metatarsal 214, fifth metatarsal 216, navicular 218, cuboid 220, talus 222, and calcaneus 224, among others. The medial cuneiform 202 and the intermediate cuneiform 204 may be joined together at a first metatarsocuneiform joint, and the first metatarsal 208 and the second metatarsal 210 may be joined together at a second metatarsocuneiform joint. The foot 200 includes a set of proximal phalanges numbered first through fifth (230, 232, 234, 236, 238) and a set of distal phalanges numbered first through fifth (240, 242, 244, 246, 248) and a set of middle phalanges numbered second through fifth (250, 252, 254, 256).	147	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	FIG. 2B is a perspective lateral view of a foot 200, with bones of the foot labeled.	148	Added by DJM Jan 2024	1/6/24, 10:01 PM
View Edit Delete	PER-24	FIG. 2C is a perspective medial view of a foot illustrating a dorsal side 280 and a plantar side 282. The foot 200, as illustrated, may have a tibia 226 and a fibula 228, among others. Dorsal refers to the top of the foot. Plantar refers to the bottom of the foot. Proximal 284 is defined as “closer to the primary attachment point”. Distal 286 is defined as “further away from the attachment point”. Plantarflex or plantarflexion 288 means movement toward the plantar side 282 of a foot or hand, toward the sole or palm. Dorsiflex or dorsiflexion 290 means movement toward the dorsal side 280 of a foot or hand, toward the top. FIG. 2D is a perspective dorsal view of the foot 200. A transverse plane is the plane that shows the top of the foot. A lateral side 292 means a side furthest away from the midline of a body, or away from a plane of bilateral symmetry of the body. A medial side 294 means a side closest to the midline of a body, or toward a plane of bilateral symmetry of the body. For a Lapidus procedure, the intermetatarsal (IM) angle 296 is the angle to be corrected to remove the hallux valgus (bunion) deformity.	149	Added by DJM Jan 2024	1/6/24, 10:01 PM

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