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Delete 		TMC-PAT-4 The preoperative plan 506 assists the user, a surgeon, in performing the surgical procedure according to a recommended operative technique. Of course, the surgeon can revise, change, adjust, or not follow each step of the preoperative plan 506 as the surgeon decides in their own discretion. 436 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In the illustrated embodiment, step 514 includes the same drawing or illustration of bones of the same foot as in step 512. Similarly, step 514 illustrates the same example resection guide 820 (e.g., resection guide 820c) in the same position as in step 512. Step 514 also illustrates a fastener 710 deployed in an anchor feature 942 of the resection guide 820c. Step 514 illustrates the medial cuneiform 202 in a transparent state so a user can visualize a trajectory for the fastener 710 deployed in the anchor feature 942. 435 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 One step 512 includes a drawing or illustration of bones of a foot. The illustration can include accurate drawings, prints, and/or representations of the bones of a foot of a particular patient. For example, the illustration can be generated based on the medical imaging referred to in the present disclosure. In one embodiment, the illustration shows the bones of the foot of a patient prior to completing a surgical procedure. In the example illustration, the bones of the foot are configured to represent bones of a patient foot that includes a deformity. The illustration shows the first metatarsal 208 extends medially rather than parallel to the second metatarsal 210. The illustration also shows a representation of a resection guide 820 (e.g., resection guide 820c) positioned on a dorsal surface of a medial cuneiform 202, extending over a first TMT joint, and on a dorsal surface of a first metatarsal 208. 434 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 FIG. 14 illustrates a page from a preoperative plan 506 and a medical image 1400 of a patient-specific guide positioned on a patient according to one embodiment. FIG. 14 illustrates two steps in an example preoperative plan 506. The example preoperative plan 506 shown may be similar to the preoperative plans 506 described in relation to FIG. 5. The preoperative plan 506 can include a plurality of steps. The preoperative plan 506 can exist in a variety of formats including data on a computer storage device or memory, a printed format, a set of physical models, or the like. FIG. 14 illustrates one page of a preoperative plan 506 showing two steps 512, 514. 433 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In another example, the anatomical data about a patient available from the medical imaging and/or a model of patient anatomy (e.g., bone model) can be used to define other instruments for a surgical procedure. For example, when a Lapidus procedure is performed it can be helpful to have a positioner that can be placed between the first metatarsal 208 and the second metatarsal 210 to position the first metatarsal 208 for the surgical procedure. The positioner can be patient-specific and/or can be patient-matched (patient-matched refers to an instrument or device that is selected from a set of pre-fabricated instruments or devices to satisfactorily service a user based on a set of characteristics, such as size of the foot, size of the deformity, angles for certain landmarks, angles for a deformity, type of deformity, size of the bone, and the like). Alternatively, or in addition, a positioner can be used with the bone model 404 to assist in positioning one or more models of bones of a patient in order to define, determine, and/or design one or more other instruments of a system (e.g., resection guide 820a, resection guide 820b, resection guide 820c, or the like). 432 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 For example, in one embodiment, patient imaging data can be used to define a distance between at a top edge (e.g., superior side 914) of a resection guide (e.g., resection guide 820a, resection guide 820b, resection guide 820c) and a first surface (e.g., a surface of a first bone such as a medial cuneiform) or a bottom edge (e.g., an inferior side 916). Managing the distance between a top edge and a bone surface or bottom edge is one way to provide a stop within the resection guide. The stop can serve to limit how deep a surgeon will resect hard tissue/soft tissue when using the resection guide 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). 431 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 Those of skill in the art will appreciate that, in one embodiment, anatomical data about the patient can be used to define other structures of the system (e.g., system 700 or system 800) 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 are. Controlling the depth of the resection features can be used to manage how deep a surgeon’s cutting instruments can reach within the resection features. Managing a depth for one or more resection features may be referred to as defining a patient specific height for a resection guide. 430 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 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. 429 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 Next, a surgeon may reduce the osteotomies and combine the two bones at the cut surfaces. This can be done manually, or a compressor and/or a compression block may engage one or more of the fasteners. As described herein, this reduction and/or compression translates one or more of the bones and/or can rotate one or more of the bones to provide a rotational correction for a deformity. After compression, a surgeon may secure the two bones together with either provisional or permanent fixation and may deploy one or more implants to hold the bones in place. 428 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 Next, a surgeon may remove a fastener of the anchor feature 942 and/or one or more fasteners in the first bone attachment feature 908 and/or second bone attachment feature 910 and remove the resection guide 820c. All the fasteners may be removed, or select fasteners may be removed, such that the resection guide 820c can be removed and certain fasteners may remain in the bone(s). In certain embodiments, certain fasteners may be reinserted into the same holes used previously. 427 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 Next, a surgeon can resect the first metatarsal 208 using the distal resection feature 904 and the medial cuneiform 202 using the proximal resection feature 902. After resection, the two cut surfaces may be prepared for fusion of the two bones by pressing the two cut surfaces against each other. Alternatively, or in addition, a surgeon may prepare the cut surfaces using a rasp or other instrument to facilitate a union of the bones. 425 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In certain embodiments, a surgeon may also deploy a fastener in an anchor feature 942 to provide further stability and engagement of the resection guide 820c with the one or more bones. 424 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 At this stage, a surgeon may use fluoroscopy to confirm that the trajectories of fasteners in the first bone attachment feature 908 and/or second bone attachment feature 910 have trajectories that correlate to desired trajectories that osteotomies formed using the proximal resection feature 902 and distal resection feature 904 will have. This is because the trajectory of the proximal resection feature 902 is parallel to the trajectory of the first bone attachment feature 908 and the trajectory of the distal resection feature 904 is parallel to the trajectory of the second bone attachment feature 910. 423 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 After the resection guide 820c “locks into place” a surgeon may deploy one or more fasteners into the first bone attachment feature 908 and/or the second bone attachment feature 910 to secure the resection guide 820c to one or more bones. A fastener deployed in the first bone attachment feature 908 can enter the medial cuneiform 202. A fastener deployed in the second bone attachment feature 910 can enter the first metatarsal 208. Additional fasteners may be deployed into the bones using the first bone attachment feature 908 and second bone attachment feature 910. 422 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 This registration can, in certain embodiments, be detected by a tactile change in how the resection guide 820c moves in relation to the bone. At one point, the resection guide 820c may move freely, but once registered, the resection guide 820c may “lock into place” and no longer readily move or translate in relation to the bone. 421 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 Returning to an example medical procedure that uses the resection guide (e.g., any of the embodiments of resection guides of the present disclosure), after a surgeon positions the resection guide 820c on a surface of one or more bones, a surgeon may next translate and/or rotate the resection guide 820c until the bone engagement feature 912 engages with one or more bones and/or bone structures (e.g., surfaces) and registers with the bone(s). For example, the bone engagement surface 944 may interlock with a cortical surface of one or more bones. Similarly, a landmark registration feature 1004 may engage with a bone structure, such as joint and/or a base of a metatarsal. 420 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In certain embodiments, four contact points may be used. Those of skill in the art will appreciate that with respect to the contact points for the bone engagement feature 912 structures other than a contoured surface can be used. For example, projections from the inferior side 916 can extend towards and contact the bone. Alternatively, or in addition, sections of the inferior side 916 can be recessed such that sections, portions, or areas of contoured sections can be formed that are contoured to mirror and match and/or mate with corresponding areas on a surface of a bone. The size, shape, surface contour, and configuration of these contoured sections can be patient-specific and can be defined using a bone model of a bone of a patient. These areas of contoured sections may resemble pads or feet that contact a surface or other structure of a bone. 419 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 For example, referring to FIGS. 13, 10D and 10E, a bone engagement feature 912 can be configured to wrap around multiple surfaces of a bone. With such a configuration, the bone engagement feature 912 may not need to contact more than three or four parts of the bone in order to accurately register and orient a resection guide 820c with the bone. In FIGs 10D and 10E, a proximal and distal view of the distal side 920 and medial side 922 is illustrated. This view shows a concave area where a bone such as a metatarsal will be positioned, when the resection guide 820c is positioned before being secured to the bone(s). Advantageously, the body 900 and bone engagement feature 912 are configured to contact the bone (which has a medial, dorsal, and lateral cortex with an irregular semicircle and/or wedge shaped cross section) in about three areas (e.g., a medial cortex area M , a dorsal cortex area D, and a lateral cortex area L). In certain embodiments, contact with the bone in these three areas can be sufficient to register the resection guide 820c in the desired location relative to the bone. Of course, more contact areas can be employed to further facilitate placement and registration of the resection guide 820c relative to the bone. 418 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 One goal of the bone engagement feature 912 is to accurately engage with and/or position a structure in relation to one or more bones, bone fragments, or parts of a bone such as one or more cortical surfaces of one or more bones. Advantageously, embodiments of the present disclosure can accurately position a patient-specific such as a resection guide 820c in relation to one or more bones, such as those of a TMT joint. In certain embodiments, a bone engagement feature 912 may be configured to accurately engage with the one or more bones or bone parts or bone surfaces using a minimal number of contact points and/or contact surfaces. 417 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 The bone engagement surface 944 can extend across the entire inferior side 916 including features such as inferior sides of the first bone attachment feature 908 and/or second bone attachment feature 910, anchor feature 942 and the like. Alternatively, or in addition, the bone engagement surface 944 may extend over a smaller portion of the inferior side 916. 416 Added by DJM Jan 2024 1/3/24, 4:24 AM

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