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Delete 		PER-23 FIGS. 13A-13D illustrate views of an example resection guide 1220 of the system 1200 of FIG. 12, according to one embodiment. The resection guide 1220 includes one or more resection features 722, one or more bone attachment features 724, and/or one or more bone engagement surfaces 726. In certain embodiments, the resection guide 1220 may include one or more landmark registration features 728. Other embodiments may not include landmark registration features 728. The resection guide 1220 includes a body 732 that connects one or more resection features 722, one or more bone attachment features 724, and/or one or more bone engagement surfaces 726. 361 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Those of skill in the art will appreciate that the resection guide 1220 can be used for a variety of procedures in a hindfoot, midfoot, forefoot, hand, wrist, elbow, shoulder, and/or the like. One skilled in the art can appreciate that the presented embodiments may be modified, revised, or repositioned to address a surgeon’s particular angles, approach, entry locations and/or preferences. 376 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 As explained above, the resection guide 1220 can be positioned, sized, configured, and oriented and/or trajectories set for the resection guide 1220 preoperatively using bone models. Additionally, a surgeon can provide a prescription for the location of guide features (e.g., resection features 722) to account for other conditions of a particular patient. 375 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Those of skill in the art will appreciate that for certain patients with certain pathologies, the form and/or shape of the resection guide 1220 can be different. For example, suppose midfoot bones of a patient have deteriorated such that a larger wedge is to be resected than the example shown in FIG. 14. In such an embodiment, the body 732 of the resection guide 1220 may be longer such that one resection feature is positioned near a distal end of the navicular 218 and another resection feature is positioned on, or near, a base of one or more metatarsals. 374 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 With the resection completed, the resection guide 1220 can be removed and the fasteners 710 used to translate and/or rotate the proximal and distal bone or bone fragments of the midfoot. In one embodiment, a compressor or distractor can be deployed over the fasteners 710 to facilitate joining the cut surfaces and/or fusing the bones. 373 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 FIG. 14B is a close-up view of the same stage illustrated in FIG. 14A. A surgeon may then continue to a surgical procedure to deploy an implant and/or fuse the resected surfaces of the one or more bones. In certain procedures, such as those to address a charcot condition, the resections may extend from the medial side of the foot to the lateral side. Alternatively, or in addition, the resections may cross each other within the foot and form a wedge shape that can be used to address the condition. 372 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 FIG. 14 illustrates one example of a resection guide 1220 coupled to the bones using bone attachment features 724 that include fasteners 710, e.g., K-wires. In one embodiment, a surgeon has formed an incision down to the cortical bone surface with a lateral approach. In the illustrated embodiment, the resection guide 1220 may be configured (e.g., using the bone engagement surface 726) to seat near where the lateral cuneiform 206 contacts the navicular 218. The surgeon has deployed two or more fasteners 710 (e.g., K-wires) through the holes 764 of the bone attachment features 724. The surgeon has also resected the bones to remove a wedge shape that extends from the lateral side of the foot toward the medial side. Here, the two cuts may form two cut surfaces that form a wedge shape of bone that has been removed to perform a midfoot closing wedge osteotomy. 371 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 FIG. 14 illustrates a stage of performing a surgical procedure using a lateral approach to form a closing wedge. FIG. 14 illustrates a dorsal perspective view of a foot and ankle including a talus 222, a calcaneus 224, a tibia 226, and a navicular 218. Certain patients may present with midfoot bones having a variety of conditions. Due to age, disease, deformity, or different pathologies, the bones of the midfoot may be deteriorated to the point that individual bones may be challenging to distinguish from each other. FIG. 14 illustrates one such example. The division between the talus 222 and the navicular 218 may be challenging to distinguish. Also, the medial cuneiform 202, intermediate cuneiform 204, and/or lateral cuneiform 206 may be challenging to distinguish from each other. 370 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Advantageously, the present disclosure can facilitate conventional surgical techniques by using the systems disclosed herein. As explained above, the bone attachment features 724 may be configured to facilitate using fasteners 710 deployed in holes 764 to serve the same purpose as the fasteners used in conventional midfoot surgical procedures. One way this can be accomplished is by having a trajectory for fasteners 710 in the bone attachment feature 724 extend parallel to a trajectory for one or the other or for each of the proximal resection feature 758 and the distal resection feature 762. Alternatively, or in addition, the holes 764 can be angled to have the same trajectory a surgeon desires for the resection of bone, such as a resection of a wedge. In this manner, the fasteners 710 in the holes 764 of the bone attachment features 724 can serve to guide a surgeon to ensure that they do not resect beyond the position of the fasteners 710. Advantageously, the embodiments of the resection guide 720 and/or the preoperative planning of the present disclosure can provide a surgeon with the confidence that resection using the resection features 722 will be as planned that costly intraoperative medical imaging can be avoided. This can save costs for the surgical procedures and time and minimize patient exposure to radiation emitted by the medical imaging equipment. 369 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 If the imaging confirms the fasteners are in a desired position with a desired orientation, a surgeon may resect one or more bones by moving a cutting tool between and/or along the deployed fasteners. In this manner the fasteners may serve as a stop or guide to prevent resection beyond the position of the fasteners. 368 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 For example, in certain medial midfoot and/or lateral midfoot surgical procedures a surgeon may prefer to deploy one or more fasteners at a predetermined angle or trajectory into one or more bones of the midfoot prior to making any resection. The surgeon may then use imaging techniques such as fluoroscopy to verify that the fasteners are in the desired position and have the desired trajectory and/or have a desired depth. If the imaging indicates the fasteners are in not a desired position with a desired orientation, a surgeon may re-deploy one or more fasteners and then re-check the position using medical imaging equipment. 367 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Conventional surgical procedures on the midfoot can be done to address a variety of pathologies and/or conditions of a patient’s anatomy. Furthermore, a variety of wedge resections, opening wedge, closing wedge, and the like can be performed to address varus, valgus, dorsiflexion, plantarflexion and other orientation conditions of the foot generally and/or particular bones of the foot. Advantageously, the patient-specific apparatus, methods, and systems of the present disclosure can be implemented based on patient imaging data to address these various conditions. In addition, the medical techniques that incorporate the patient-specific apparatus, methods, and systems of the present disclosure can include certain conventional steps and stages and new stages or steps that are enabled by the present disclosure. 366 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In certain embodiments, the landmark registration feature 728 can be shaped like a hook to engage a surface of bone. Alternatively, or in addition, the resection guide 1220 may include a landmark registration feature 728 on different sides, together the landmark registration features 728 can engage one or more landmarks of a surface of the bone such that the surgeon can accurately position and register the resection guide 1220 to the bone. 365 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In the illustrated embodiment, one landmark registration feature 728 may extend from the medial side 744 or the first bone attachment feature 766. Advantageously, the landmark registration feature 728 can provide a surgeon with confidence and assurance in the placement and positioning of the resection guide 1220 on a bone because the landmark registration feature 728 can be configured to engage with a particular landmark on the bone or other patient anatomy (e.g., a projection or a depression or cavity). Alternatively, or in addition, the landmark registration feature 728 can include a contoured bone engagement surface that can further facilitate registration of the landmark registration feature 728 and/or resection guide 1220 with the bone. In this manner, a surgeon can be assured intraoperatively that the resection guide 1220 is being positioned in accordance with a preoperative plan. 364 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The resection guide 1220 includes an anterior side 734, a posterior side 736, a plantar side 738, a dorsal side 742, a medial side 744, and a lateral side 746. FIG. 13A is a lateral perspective view. FIG. 13B is a dorsal perspective view. FIG. 13C is medial side perspective view. FIG. 13D is an anterior side perspective view. 363 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In the illustrated embodiment, the posterior side 736 includes a first bone attachment feature 766 and the anterior side 734 includes a second bone attachment feature 768. In one embodiment, the holes 764 of the first bone attachment feature 766 are aligned (along a longitudinal axis of the body 732) with the second bone attachment feature 768. Alternatively, or in addition, the first bone attachment feature 766 and second bone attachment feature 768 are not aligned with each other. 362 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The bone fragment(s) of the wedge osteotomy can be removed to perform for example, a midfoot closing wedge osteotomy. A surgeon may then continue to a surgical procedure to deploy an implant (e.g., a beam), and/or fuse the resected surfaces of the one or more bones. In certain procedures, such as those to address a Charcot condition, the resections may extend from the medial side of the foot to the lateral side. Alternatively, or in addition, the resections may cross each other within the foot and form a wedge shape that can be used to address the condition. 352 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 For example, the osteotomy (e.g., first osteotomy) formed using the proximal resection feature 1112 may extend through the midfoot from the medial side to the lateral side. Similarly, the osteotomy (e.g., second osteotomy) formed using the distal resection feature 1114 may extend through the midfoot from the medial side to the lateral side. Thus, after the first osteotomy and second osteotomy are formed the bone wedge or wedge osteotomy can include a plurality of bone fragments between the first osteotomy and the second osteotomy and between the medial side of the midfoot and the lateral side of the midfoot. 351 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Next, a surgeon can resect the first metatarsal 208 using the distal resection feature 1114 and the medial cuneiform 202 using the proximal resection feature 1112. After resection, the two cut surfaces may form a wedge shape of one or more bones. 350 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Those of skill in the art will appreciate that the exemplary system may include a resection guide designed for a particular patient and their specific bone condition. For example, event of significant loss of bone or the lack of bone with a desirable level of density and/or structural integrity, the fasteners, resection guides, and/or complementary components can be strategically designed and placed on a patient’s foot to remove pathological bone and also be used to strategically place bone void fillers such allograft, 3D printed constructs (metallic, synthetic bone or biological), and the like. In this manner, a very patient-specific solution can be realized that may involve aspects of various surgical procedures but can be done with high precision and accuracy because the patient-specific instrumentation has been developed, designed, manufactured beforehand and is used to facilitate that realization of the planned correction during the procedure. 353 Added by DJM Jan 2024 1/6/24, 9:56 PM

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