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Delete 		PER-23 Advantageously, because the present disclosure uses a bone model of the patient’s bones the sizes, dimensions, lengths and configurations of the components of the example systems can each be changed, adapted, revised, and/or customized to meet the needs and/or preferences of the patient and/or surgeon. Advantageously, using the apparatus, systems, and/or methods of the present disclosure the surgeon may have a preoperative plan that identifies which specific bone screw (length, width, diameter, thread, pitch, etc.) to use for the fasteners. 399 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 embodiments of the system disclosed herein can be used on humans and animals and on bones that are relatively small in comparison to other bones of the body (e.g., bones of the foot and hand). Advantageously, the embodiments of the system seek to minimize the number of fasteners or pins placed within the bones of a patient by planning a surgical procedure such that pins or fasteners placed in one stage are and/or can be reused in subsequent stages. Consequently, pins initially deployed can remain in the bone or bone fragment as instruments are deployed and/or subsequent stages of the surgical procedure are performed. 398 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Using the resection guide 1620 a plurality of wedge segments may be formed using a single resection guide to form two or more wedge segments. Those of skill in the art will appreciate that the resection guide 1620 can be configured, positioned, and secured in a single step and span a plurality of joints for performing multiple osteotomies. 397 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The resection guide 1620 includes a first bone attachment feature 1644 configured to receive a first fastener to secure the resection guide 1620 to the midfoot of the patient. The resection guide 1620 also includes a second bone attachment feature 1646 configured to receive a second fastener to secure the resection guide to the midfoot and a third bone attachment feature 1648 configured to receive a third fastener to secure the resection guide to the midfoot. In the illustrated embodiment, the second bone attachment feature 1646 is between the second resection feature 1624 and the third resection feature 1626. 396 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 When a surgeon forms a first osteotomy with the first resection feature 1622, the second osteotomy with the second resection feature 1624, the third osteotomy with the third resection feature 1626, and the fourth osteotomy with the fourth resection feature 1628, this creates a remainder bone portion 1642. The remainder bone portion 1642 is one or more bone fragments that remain within the midfoot after completion of the osteotomies (first, second, third, and fourth). The remainder bone portion 1642 is one or more bone fragments that remain within the midfoot when the osteotomies are reduced. In the illustrated embodiment, the remainder bone portion 1642 may include part of the navicular 218, part of the intermediate cuneiform 204, part of the lateral cuneiform 206, and/or part of the cuboid 220. Reducing the osteotomies may sandwich the remainder bone portion 1642 between the second osteotomy and the third osteotomy. Advantageously, the ability to create and retain a remainder bone portion 1642 can be useful for a surgical procedure where the quality and condition of the bones varies. For example, surgeon may design the remainder bone portion 1642 to include bone segments or fragments that are of higher quality or condition to help achieve the goals of the surgical procedure. 395 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Depending on the surgical procedure, the needs of the patient, and/or the condition of the bones and other tissues, for certain corrections and/or conditions, the surgeon may resect from the medial side of the foot to the lateral side of the midfoot. Advantageously, the first trajectory 1630 cooperates with the second trajectory 1632 to form a first bone wedge 1638. The third trajectory 1634 cooperates with the fourth trajectory 1636 to form a second bone wedge 1640. Since the osteotomies may extend through a plurality of bones, the first bone wedge 1638 and/or second bone wedge 1640 can includes a plurality of bone fragments. 394 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The resection guide 1620 includes a fourth resection feature 1628 that extends from the medial side 744 to the lateral side 746. The fourth resection feature 1628 is configured to guide a cutting tool to form a fourth osteotomy in at least one midfoot bone (e.g., a medial cuneiform 202). The fourth trajectory 1636 defined, at least in part, by the fourth resection feature 1628 for the fourth osteotomy is determined based on the bone model 404. 393 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 By using two or more wedge segments, a surgeon may combine the effect of the two or more wedge segments to create a single correction angle that is in a single plane, in two planes, in three planes, or the like. Accordingly, the exemplary system 1500 may include multiple resection guides 1520, fasteners 710, and/or complementary components 730. 385 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In the illustrated embodiment, a surgeon may plan to resect a wedge segment from each of a tarsometatarsal joint 1502 (“TMT” or Lisfranc joint), a cuneonavicular joint 1504, and a talocancaneonavicular joint 1506 in order to accomplish a desired correction. FIG. 15 illustrates a medial perspective view of bones of a foot. The medial cuneiform 202, first metatarsal 208, navicular 218, talus 222, calcaneus 224, and tibia 226 are illustrated. 378 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In the illustrated embodiment, three resection guides 820 (first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c) may be used for form resection cuts to form wedge segments for three separate closing wedge osteotomies. These wedge segments may extend part way into the foot, or through from one side of the foot to the other. 379 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Advantageously, the apparatuses, systems, and methods of the present disclosure can be used to plan these osteotomies, determine the desired angles (in one, two, or three planes) for cuts for each wedge segment, a desired depth for the cuts, define suitable resection guides for the surgical procedure, manufacture suitable resection guides for the surgical procedure, and demonstrate how the anatomy will look or reduce once the osteotomies are completed, the bones are positioned, and the surgical procedure is completed. 380 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In the illustrated embodiment, a first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c may be designed, developed, and/or fabricated for the procedure. Or course, each of the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c may have one or more resection features and each of the one or more resection features 722 may have a different angle relative to one or more references planes of the foot and/or in relation to each other. In the illustrated embodiment, the angles of the resection features for each of the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c may be defined to correspond to the angles desired for the correction. 381 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In the illustrated embodiment, each of the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c can be positioned on the bones as illustrated. Advantageously, each of the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c may include a bone engagement surface 726 that facilitates locating and positioning the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c at each desired location. Furthermore, one or more fasteners 710 may secure the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c to the bones. 382 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c may be secured using one or more bone attachment features 724. In certain embodiments, one or more bone attachment features 724 for a single resection guide may cooperate with bone attachment features 724 of an adjacent bone attachment feature 724. For example, once a distal bone attachment feature 724 of distal resection guide 720 (e.g., first resection guide 1520a) is secured using a fastener 710, a fastener 710 deployed in an opening of a proximal bone attachment feature 724 of the distal resection guide 720 (e.g., first resection guide 1520a) can also pass through an opening of a distal bone attachment feature 724 of an intermedial resection guide 720 (e.g., second resection guide 1520b). In this manner, a single fasteners 710 can secure two ends of two different resection guides 720. This same pattern can be used to secure the intermedial resection guide 720 (e.g., second resection guide 1520b) to a proximal resection guide 720 (e.g., third resection guide 1520c). 383 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Of course, at the discretion of the surgeon each of the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c may be placed and secured in one stage of the procedure. Or, each of the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c may be positioned and secured in sequence. Furthermore, resections may be performed using one or more of the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c in series and/or in sequence, again at the discretion of the surgeon. 384 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The resection guide 1620 may have many structures, features, and functions, operations, and/or configuration similar or identical to those of the resection guides 720 described in relation to FIGS. 7-15, like parts are identified with the same reference numerals. Accordingly, the resection guide 1620 may include a plurality of resection features, bone attachment features, bone engagement surfaces, landmark registration features, and the like. The resection guide 1620 may include a body 732, two connectors 733, anterior side 734, posterior side 736, plantar side 738, dorsal side 742, medial side 744 (facing away from the bones), and/or lateral side 746 (facing the bones). 388 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The resection guide 1620 includes a second resection feature 1624 that extends from the medial side 744 to the lateral side 746. The second resection feature 1624 is configured to guide a cutting tool to form a second osteotomy in at least one midfoot bone (e.g., a navicular 218). The second trajectory 1632 defined, at least in part, by the second resection feature 1624 for the second osteotomy is determined based on the bone model 404. 391 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In addition, the resection guide 1620 includes a first resection feature 1622 that extends from the medial side 744 to the lateral side 746. The first resection feature 1622 is configured to guide a cutting tool to form a first osteotomy in at least one midfoot bone (e.g., a talus 222). The first trajectory 1630 defined, at least in part, by the first resection feature 1622 for the first osteotomy is determined based on the bone model 404 of a plurality of midfoot bones. The bone model 404 is based on medical imaging of the patient’s foot. The bone model 404 is configured to significantly resemble the anatomy of the patient's foot. 390 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In one embodiment, the resection guide 1620 includes a bone engagement surface (between the resection guide 1620 and the bones) that spans the lateral side 746 of the body 732. The bone engagement surface includes at least one patient-specific surface that can include a contour that mirrors a contour of at least one bone (e.g., medial cuneiform 202, navicular 218, and/or talus 222) of a midfoot. The patient-specific surface is defined at least in part using a bone model 404 of at least one bone (e.g., a midfoot bone) of the patient’s foot. 389 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The body 1110 includes an anterior side, a posterior side, a medial side, a lateral side, a dorsal side, and a plantar side. Each side is named based on the direction or position of the side when the resection guide 720 is in use. In addition, the body 1110 includes a bone engagement surface (not visible in FIG. 11). Like the bone engagement surface 726 described in connection with other embodiments, the bone engagement surface may span the lateral side of the body 1110. Advantageously, the bone engagement surface includes a patient-specific surface that includes a contour that mirrors a contour of a plurality of midfoot bones (e.g., medial cuneiform 202 and/or first metatarsal 208). The patient-specific surface is defined at least in part using a bone model 404 of at least one bone of the patient’s foot. The bone engagement surface is on a bone-facing surface of the body 1110 when the resection guide 720 is in use. The bone engagement surface assists a surgeon in positioning the resection guide 720 in the same or substantially the same position as predetermined using a model of the resection guide 720 and/or one or more models of one or more bones of the patient. 346 Added by DJM Jan 2024 1/6/24, 9:56 PM

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