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Advantageously, the digital fulcrum design tool 414 enables a user to do in a virtual environment the same steps that the user might do in an actual environment during a surgical procedure.  For example, in certain surgical procedures, a user may manipulate the position of the first metatarsal 208 in relation to the second metatarsal 210 and use a physical fulcrum instrument or positioner to guide this positioning and/or manipulation. In such a technique, the physical fulcrum instrument or positioner may remain in place as a surgeon determines position and/or trajectories for one or more fasteners and/or guides such as a resection guide. Using the system 400, a user can determine the positions and/or trajectories for fasteners (e.g., K-wires or pins), a resection guide, patient-specific aspects of the resection guide or other instrumentation, in the virtual environment. Those determinations can be preserved by the features created in a patient-specific instrument 406 fabricated using the apparatus 402. For example, holes formed in a resection guide may be positioned and oriented based on a configuration done using the apparatus 402. Fasteners or pins deployed into one or more bones of a patient through the holes may be used to secure a resection guide and then subsequently used to translate and/or rotate the one or more bones during a reduction and/or subsequent fusion of the one or more bones (e.g., a compressor may slide over the fasteners to assist in a reduction).

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