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Delete 		PER-23 Referring to FIG. 10A, in one embodiment, anatomical data about the patient can be used to define other structures of the resection guide 720a or other patient specific instruments. For example, anatomical data about the patient that can be captured in the patient imaging data (e.g., due to the fidelity of the technology providing the patient imaging data) can be used to define how deep one or more resection features 722 are. Controlling the depth of the resection features 722 can be used to manage how deep a surgeon’s cutting instruments can reach within the resection features 722. Managing a depth for one or more resection features may be referred to as defining a patient specific height for the resection guide 720a. 341 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 For example, in one embodiment, patient imaging data can be used to define a distance between at a first top edge of the resection feature 722b (e.g., proximal resection feature 758) and a first surface (e.g., a surface of a first bone such as a medial cuneiform). Alternatively, or in addition, patient imaging data can be used to define a distance between at a second top edge of the resection feature 722a (e.g., distal resection feature 762) and a second surface (e.g., a surface of a second bone, such as a first metatarsal). Managing the distance between a first top edge and/or second top edge and a bone surface is one way to provide a stop within the resection guide 720. The stop can serve to limit how deep a surgeon will resect hard tissue/soft tissue when using the resection guide 720 for a procedure. If a surgeon resects until the resection instruments engages the stop, the surgeon can be assured that the resection extends to a desired depth (not too far and not too short). 342 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 FIG. 11 illustrates a stage of performing a surgical procedure using a wedge osteotomy system, such as exemplary system 700, or system 800. FIG. 11 illustrates a medial perspective view of a foot and ankle including a medial cuneiform 202, a first metatarsal 208, a second metatarsal 210, a talus 222, a calcaneus 224, a tibia 226, and a navicular 218. FIG. 11 illustrates one example of a resection guide 720 coupled to the bones using bone attachment features 724 that include a first fastener 710a and second fastener 710b, e.g., K-wires. The fasteners 710a,b each engage a midfoot bone of a patient’s foot. In one embodiment, the fasteners 710a,b each engage the same midfoot bone or bones (e.g., fastener 710a may extend through first metatarsal 208 and into second metatarsal 210). Alternatively, or in addition, the fasteners 710a,b each engage a different midfoot bone or bones. 343 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The resection features 722a,b guide a surgeon in performing a resection by facilitating keeping a cutting tool in line with and/or within an opening of the resection features 722a,b (at a desired trajectory relative to one or more bones of the patient). In the illustrated embodiments, the resection features 722 are shaped like slots or channels and include an open end 729 and a closed end 731. One difference between the illustrated embodiments of the resection guides 720a,b,c may be the relationship of the open end 729 and closed end 731 of one resection feature 722 in relation to another resection feature 722 of the same resection guide 720. Another difference may be a relationship of the open end 729 and closed end 731 of one resection feature 722 in relation to another resection guide 720a,b,c. 253 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 resection guides 720a,b,c may be configured for use on a medial side of a midfoot of a patient, with the side visible in FIG. 7 facing away from the bone(s). The resection features 722a,b may be positioned and oriented relative to each other to facilitate forming cuts for a wedge that can be resected to form a closing wedge. One resection guide 720 (e.g., resection guide 720a) may be configured to facilitate forming a wedge resection (e.g., bone wedge) that opens towards a plantar side of the midfoot. Another resection guide 720 (e.g., resection guide 720b) may be configured to facilitate forming a wedge resection (e.g., bone wedge) that opens to a dorsal side of the midfoot. Both resection guide 720a and resection guide 720b include resection features 722a,b with the open ends 730 and closed ends 731 on same side. Of course, the open ends 730 and closed ends 731 of resection guide 720b or resection guide 720a can also be on opposite sides of each other (like resection guide 720c). Another resection guide 720 (e.g., resection guide 720c) may be configured to facilitate forming a wedge resection that opens to a plantar side of the midfoot. The open ends 730 and closed ends 731 of resection guide 720c are on opposites sides in the resection guide 720c. 254 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 720 may have a variety of shapes, sizes and configurations. In one embodiment, these attributes can each be customized and adapted to meet needs or preferences of patients, a patient’s anatomy, the nature of the deformity, and/or surgeon preferences. Advantageously, the features of the resection guides 720 can facilitate one or more osteotomies as well as other steps in a surgical procedure. 255 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Advantageously, the angle of each resection feature 722 relative to each other and relative to one or more bones (or bone surfaces or other reference points, reference lines, and/or reference planes) can be determined, selected, or indicated by a surgeon before the resection guide 720 is fabricated. Similarly, a surgeon can designate whether they want a resection guide 720 for forming a plantar opening wedge or a dorsal opening wedge. In addition, a surgeon can designate which sides of the resection features 722 are open end 729 or closed end 731 which can result in an embodiment such as resection guide 720a, resection guide 720b, or resection guide 720c. 256 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 FIG. 9A illustrates an example resection guide 720. The example resection guide 720 includes a proximal resection feature 758 connected to the body 732 having an open end 729 that is open at the plantar side 738 (e.g., an open plantar end) and a closed end 731 that is closed at the dorsal side 742 (e.g., a closed dorsal end). The example resection guide 720 includes a distal resection feature 762 connected to the body 732 having an open end 729 that is also open at the plantar side 738 (e.g., an open plantar end) and a closed end 731 that is also closed at the dorsal side 742 (e.g., a closed dorsal end). In certain embodiments and/or for certain surgeons having two ends of the resection features 722 may facilitate forming a first osteotomy and a second osteotomy using the resection features 722. For example, a surgeon may insert a cutting tool having a common orientation and/or position for both resection features 722 and make a similar cutting motion to form the osteotomies in each resection features 722. This can simplify the osteotomy procedures for the surgeon and/or assistants during the surgical procedure. 257 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 FIGS. 9A-9D illustrate views of an example resection guide 720a of the system 800 of FIG. 8, according to one embodiment. The resection guide 720a 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 720 may include one or more landmark registration features 728. Other embodiments may not include landmark registration features 728. The resection guide 720a 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. The resection guide 720a 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. In one embodiment, the resection guide 720a is configured for use on a medial side of a midfoot of a patient. Thus, the resection guide 720a can be referred to as a medial resection guide. The names of the sides of the resection guide 720a refer to the position of the sides when the resection guide 720a is in use on one or more bones of the midfoot. 258 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 FIG. 9A is an inferior perspective view. FIG. 9B is a superior perspective view. FIG. 9C is lateral side perspective view. FIG. 9D is a posterior side perspective view. 259 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The body 732 may include resection features 722 that guide a cutting tool to resect one or more bones, such as a medial cuneiform and/or a first metatarsal in the manner needed to make the desired resection. For example, the resection features 722 may be used to guide a planar cutting blade, an arcuate cutting blade, a drill or mill, a burr, and/or the like. The resection features 722 may guide a reciprocating planar blade, such as that of a surgical bone saw, that forms planar cuts in a first cuneiform and a first metatarsal. Various manual or powered tools may be used to form the planar cuts. In one embodiment, a sagittal bone saw can be used. 260 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In one embodiment, the proximal resection feature 758 guides a cutting tool to form a first osteotomy in one or more bones of a patient. Similarly, the distal resection feature 762 is used to form a second osteotomy in one or more bones of the patient. Advantageously, the first osteotomy and the second osteotomy can be configured to resect a desired amount, size, and/or shape of bone or bones and/or soft tissue from a midfoot of the patient. 261 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In one example, the resection features 722 may take the form of a proximal resection feature 758 and a distal resection feature 762. In one embodiment, the proximal resection feature 758 and the distal resection feature 762 extend from the medial side 744 to the lateral side 746. For example, the proximal resection feature 758 may extend through the body 732 of the resection guide 720a from the medial side 744 to the lateral side 746 along a first trajectory 902. Similarly, the proximal resection feature 758 may extend through the body 732 of the resection guide 720a from the medial side 744 to the lateral side 746 along a second trajectory 904. 262 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Advantageously, the proximal resection feature 758 and/or distal resection feature 762 can be defined based on, in connection with, and/or may be defined at least partially based on a bone model 404 of one or more bones of a midfoot of a patient. The bone model 404 provides a detailed and accurate representation of the midfoot bones of the patient. Using the apparatuses, systems, and/or methods of the present disclosure the resection guide 720a and/or its components such as the proximal resection feature 758 and distal resection feature 762 can be configured for a specific patient, for a specific surgical procedure, and/or according to specific user instructions and/or preferences of a user (e.g., surgeon). 263 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In one embodiment, the first trajectory 902 is wholly or at least partially determined based on a bone model 404 of the patient’s foot. In particular, the bone model 404 may be of one or more bones, joints, and/or tissues of a midfoot of the patient. The bone model 404 is defined based on medical imaging of the patient’s foot such that the bone model 404 and surfaces and structures of the bone model 404 are highly accurate representations of the actual midfoot bones of a particular patient. The accuracy of the bone model 404 is such that any protuberance, eminence, bony topography, anatomical features, calcifications, void, divot, concave section, sesamoid, bone spur or other feature on, or extending from, a bone of a patient are represented in the bone model 404 (including on surfaces of model bones of the bone model 404). 264 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Alternatively, or in addition, the second trajectory 904 can be wholly or at least partially determined based on one or both of the bone model 404 and the first trajectory 902. For example, in one embodiment, the bone model 404 is used to determine, at least in part, the second trajectory 904. Alternatively, the second trajectory 904 can be defined to be a certain offset, orientation, and/or angle in relation to the first trajectory 902. 265 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In certain embodiments, the proximal resection feature 758 may extend from near the dorsal side 742 to near the plantar side 738. In other embodiments, one of, or both of, the proximal resection feature 758 and the distal resection feature 762 may extend from one of the dorsal side 742 or the plantar side 738 of the body 732. In certain embodiments, the proximal resection feature 758 and distal resection feature 762 intersect each other. In other embodiments, the proximal resection feature 758 and distal resection feature 762 do not intersect. 266 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Thus, upon desired positioning of the resection guide 720 for use, the proximal resection feature 758 may be positioned over at least a portion of a first medial cuneiform or other midfoot bone (e.g., navicular 218), particularly where the resection guide 720 is a medial resection guide, while the distal resection feature 762 may be positioned over, for example, a portion of the first metatarsal 208. In one embodiment, the proximal resection feature 758 is positioned near the distal end of the first cuneiform and the distal resection feature 762 is positioned near the proximal end of the first metatarsal. The proximal resection feature 758 and distal resection feature 762 together, with the bone engagement surface 726 overlying the first cuneiform and the first metatarsal, are positioned to guide resection of one or more midfoot bones during a surgical osteotomy for correcting a condition. 267 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In alternative embodiments, a resection feature may be designed to guide a different type of cutter, such as a drill, mill, or side-cutting burr. In such embodiments, the resection feature may not be a slot, but may instead be a translatable or rotatable cutter retainer that guides translation and/or rotation of the cutter relative to the bone. In certain embodiments, two or more resection features may be replaced by a single resection feature sized to permit a surgeon to resect multiple midfoot bones using a resection guide 720. 268 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In one embodiment, a proximal resection feature 758 is configured to define a first cut surface that can be formed by resecting a first bone. A distal resection feature 762 is configured to define a second cut surface that can be formed by resecting a second bone. In such an embodiment, one or the other or both of the first cut surface and the second cut surface can be oriented according to one or more angles relative to landmarks on the bones or other anatomical structures. 269 Added by DJM Jan 2024 1/6/24, 9:56 PM

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