Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-33	In one embodiment, the fastener 910 is an eyelet pin having an eyelet 912. The fastener 910 may be supplied with the tendon trajectory guide 1120 and/or may be supplied in a conventional tendon transfer surgical system/kit/tray. With the fastener 910 deployed, the surgeon may then remove the tendon trajectory guide 1120 by sliding the tendon trajectory guide 1120 off of the fastener 910.	343	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	With the tendon trajectory guide 1120 and fastener 910 in place, the surgeon can next remove the tendon trajectory guide 1120 and leave the fastener 910 in place. The method may then proceed with the surgeon reaming a bone tunnel around the fastener 910 such that the bone tunnel is coaxial with the fastener 910. Next, the surgeon may follow traditional steps to attach a tendon (e.g., the FDL tendon) to the attachment point and along a trajectory provided by the tendon trajectory guide 1120 using a variety of conventional tendon transfer kits/systems/instruments or the like. For example, a surgeon may thread a suture that is whip stitched to an end of the FDL and pass the suture through a proximal eyelet of the fastener 910. Next, the surgeon may press the fastener 910 through the bone tunnel and out the dorsal (distal) opening on the superior surface of the navicular 218. In this manner, the FDL is threaded into the bone tunnel. The FDL may then be secured and/or fixated in the bone tunnel using conventional techniques and/or implants and/or fasteners.	344	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	A patient may present with a variety of conditions. To correct or mitigate these conditions, a tendon trajectory guide 1120 according to the present disclosure can be used to address dorsiflexion, plantar flexion, angular correction of a bone segment or any bone, flat foot, club foot, or a variety of foot, hand, or joint conditions. Those of skill in the art will appreciate that the tendon trajectory guide 1120 may also include bone engagement features, resection features, or the like depending on the needs of a surgeon for a particular surgical procedure.	345	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	For example, FIG. 11C illustrates an embodiment of a tendon trajectory guide 1120 that includes a bone engagement feature 1128. The bone engagement feature 1128 extends from a body of the tendon trajectory guide 1120 dorsally along a medial side of the navicular 218. In certain embodiments, the initial dimensions of the bone engagement feature 1128 may be set by a technician working with a model of the tendon trajectory guide 1120 and bone models of bones such as the navicular 218 of a patient. However, before the tendon trajectory guide 1120 a surgical procedure is performed using the tendon trajectory guide 1120 a surgeon reviews the design of the tendon trajectory guide 1120 and can revised or adjust the configuration of the bone engagement feature 1128. In this manner, the surgeon remains in control and makes the determination as to what the final design of the tendon trajectory guide 1120 should be. A surgeon can for example, request that the bone engagement feature 1128 extend less dorsally and/or extend more anteriorly, etc. The surgeon may have many reasons for making these adjustments. However, the benefit of the present disclosure is that the design of the tendon trajectory guide 1120 can be revised by the surgeon until the design matches the surgeon’s needs and/or preferences for the surgical procedure.	346	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In the illustrated embodiment, the bone engagement feature 1128 can also include a bone engagement surface 1126 on a surface that contacts and/or faces a surface of the navicular 218. Alternatively, or in addition, the bone engagement feature 1128 can include one or more landmark registration features 1124 that can further assist a surgeon in positioning the tendon trajectory guide 1120 during a surgical procedure.	347	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Those of skill in the art will appreciate that the number, size, shape, and/or other configuration aspects of a bone engagement feature 1128, in certain embodiments, can be directly proportional to a landmark configuration of a bone indicated on a bone model of one or more bones of a patient. This means, in certain embodiments, for example, that where a surface and/or area of bone includes three landmarks with a particular relationship between them, the tendon trajectory guide 1120 can include three corresponding bone engagement features 1128.	348	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	FIGs. 12A-12E illustrate different views of one embodiment of a tendon trajectory guide 1120 for the navicular 218. The tendon trajectory guide 1120 includes a body 1134 having an anterior side 1136, a posterior side 1138, a medial side 1140, a lateral side 1142, a superior side 1144, and an inferior side 1146. The tendon trajectory guide 1120 includes a bone engagement surface 1126 and opening 1134. In certain embodiments, the tendon trajectory guide 1120 may include one or more landmark registration features 1124.	349	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	A landmark registration feature 1124 can be any structure of the tendon trajectory guide 1120 that engages with, is configured to engage with, contacts and/or connects to a landmark of a bone. In the illustrated embodiment, the landmark registration feature 1124 is a lip that is configured to engage with a bone process that extends from and/or shapes the bone (e.g., navicular 218). Advantageously, a surgeon can request additional landmark registration features 1124 and/or can modify one or more landmark registration feature 1124 such that they are larger or smaller, according to their own needs and/or preferences for the surgical procedure.	350	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	The trajectory port 722 guides placement of a temporary fastener and/or forming an opening or tunnel in the bone of a patient. The landmark registration feature 724 can serve to ensure the STRG 720 is placed in a desired location on one or more bones. The bone engagement feature 726 can also serve to ensure the STRG 720 is placed in a desired location on one or more bones. In certain embodiments, the bone attachment feature 728 can include a hole in the STRG 720 that operates together with a temporary fastener such as a K-wire or pin to secure the STRG 720 to bone.	244	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In certain embodiments, a STRG 720 may include one or more bone engagement features 726 and/or one or more landmark registration features 724. In certain embodiments, a landmark registration feature 724 may extend from one or more sides or ends of a STRG 720 and engage with one or more landmarks of a bone or joint or anatomical structure of a patient. Registration of the landmark registration feature 724 to a landmark of a bone or joint can serve to confirm and/or ensure that a surgeon has located a desired placement and/or orientation for a STRG 720.	245	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In certain embodiments, the bone engagement features 726 are patient-specific: designed and/or contoured to match anatomy such as a surface of: one or more bones and/or bone surfaces the STRG 720 contacts during the procedure or one or more joints proximal to the STRG 720 during the procedure. Alternatively, or in addition, the bone engagement feature 726 may not be patient-specific, and may, or may not, contact a bone surface during use of the STRG 720. In one embodiment, a skin contact surface may be used in addition to, or in place of, a bone engagement surface. Those of skill in the art appreciate that one or more sides of any of the members of the system 700 may include one or more bone engagement features 726. Consequently, one or more sides of the fasteners 710, the resection guide(s) 720, the complementary components 730, navigation guides 792, and/or the implants 794 may include one or more bone engagement features 726.	246	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In certain embodiments, the STRGs 720 and/or aspects of the STRGs 720 may be integrated into other components and/or instruments, such as a pin guide, a trajectory guide, an alignment guide, or the like.	247	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	The complementary components 730 serve to assist a surgeon during one or more steps of a procedure. Those of skill in the art appreciate that a number of components can serve as complementary components 730. One or more of the features, functions, or aspects of the complementary components 730 can include patient-specific features. Examples of complementary components 730 include, but are not limited to, an alignment guide 740, a rotation guide 750, a reduction guide 760, a compression guide 770, a positioning guide 780, a fixation guide 790, navigation guides 792, and/or one or more implants 794. In general, the complementary components 730 serve to assist a surgeon in performing the function included in the name of the complementary component 730. Thus, an alignment guide 740 can help a surgeon align bones, parts of bones, or other parts of a patient as part of a procedure. A rotation guide 750 can help a surgeon rotate one or more bones, parts of bones, or other parts of a patient as part of a procedure. In one embodiment, a rotation guide 750 may hold one bone fragment stable while another bone fragment is rotated into a desired position.	248	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	A reduction guide 760 can help a surgeon position and/or orient one or more bones, parts of bones, or other parts of a patient as part of a procedure in order to reduce the bone, bones, bone parts, or other parts and/or in order to position and/or orient the bone, bones, bone parts, or other parts to a desired position and/or orientation. In certain embodiments, aspects and/or features of a reduction guide 760 can be integrated into one or more other components of a system 700, such as components of the complementary components 730. A compression guide 770 can help a surgeon compress one or more bones, parts of bones, or other parts of a patient together or against an implant as part of a procedure. In certain embodiments, compression guide 770 can be a separate instrument such as a compressor and/or a combined compressor/distractor. The compressor / distractor can be used to compress two or more cut faces formed by an osteotomy until fixation is deployed or distract bones or parts of bones involved in a procedure. In certain embodiments, a compression guide 770 may serve a dual purpose as both a compression guide 770 and as a positioning guide 780. The same instrument may be used to both translate and/or rotate bones or bone fragments and compress two or more cut faces formed by an osteotomy until fixation can be deployed.	249	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	A positioning guide 780 (also referred to as a positioner) can help a surgeon position one or more bones, parts of bones, or other parts of a patient as part of a procedure. For example, a positioning guide 780 may hold one bone or bone fragment stable and hold one or more other bone fragments in a desired position while permanent or temporary fixation is deployed. In certain embodiments, the positioning guide 780 may hold bone fragments in a reduced position, and thus may function as both a positioning guide 780 and/or a reduction guide 760.	250	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	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.	251	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	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.	252	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	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.	253	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	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.	254	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	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 STRG 720 can include one or more landmark registration features 724.	255	Added by DJM Jan 2024	1/6/24, 9:58 PM

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