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Delete 		TMC-PAT-4 In addition, the body 900 of the resection guide 820c includes a bone engagement surface (not visible in FIG. 13). The bone engagement surface may span the inferior side 916 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 bones. 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 900 when the resection guide 820c is in use. The bone engagement surface assists a surgeon in positioning the resection guide 820c in the same or substantially the same position as predetermined using a model of the resection guide 820c and/or one or more models of one or more bones of the patient. 415 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 Next, the surgeon positions the resection guide 820c on one or more bones so as to span the TMT joint and may extend into and/or cross a cuneonavicular joint. As described herein, the resection guide 820c is patient-specific and has been designed and/or fabricated specifically for this patient and/or for this surgical procedure. 414 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 The present disclosure includes a method of using the resection guide 820c and/or other components of the system 800. Initially, a surgeon may form an incision transverse to a tarsometatarsal (“TMT”) joint and/or a cuneonavicular joint with a dorsal approach. The resection guide 820c, in one example, may be configured (e.g., using one or more bone engagement features) to seat on and between a dorsal surface of both the medial cuneiform 202 and the first metatarsal 208. The surgeon forms the incision down to the cortical bone surface. The surgeon also cuts, or moves to the side, soft tissue covering the cortical bone surface of the bones sufficient to seat the bone engagement features to the cortical bone surface. In certain embodiments, this can include capturing and displacing the Extensor Hallucis Longus (EHL) tendon that may run along a lateral side of the TMT joint. 413 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 FIG. 13 illustrates a medial perspective view of a resection guide according to one embodiment. FIG. 13 illustrates the proximal resection feature 902, distal resection feature 904, window 906, first bone attachment feature 908, second bone attachment feature 910, and landmark registration feature 1004. In the illustrated embodiment, the landmark registration feature 1004 includes a medial surface 1006 that is contoured to match a lateral surface of a portion of a base of a metatarsal of the patient. Advantageously, the window 906 extends into the proximal resection feature 902 and the distal resection feature 904 such that a surgeon using the resection guide 820c can see (both visually and/or with the aid of fluoroscopy) the distal end of a cuneiform and a proximal end of a metatarsal of a TMT prior to making any cuts. 412 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 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. 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. 411 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 Referring still to FIG. 12, reduction of a first osteotomy of a cuneiform with a second osteotomy of a metatarsal closes the angle A from its initial number of degrees to zero degrees or substantially zero degrees and brings fourth trajectory 1110 into alignment and to be parallel to DP axis 1204. The metatarsal rotates within the frontal plane to provide a correction. Those of skill in the art will appreciate that alternative embodiments of the resection guide 820c may include a first bone attachment feature 908 and a second bone attachment feature 910 that deploys fasteners that are aligned along dorsal axis 1206 and longitudinal axis 1202. In such embodiments, a surgeon may manually rotate the metatarsal. Alternatively, or in addition, a compression block and/or reduction guide may include holes that are not aligned (e.g., proximal holes may not align with distal holes, which extend into the device at an angle similar to angle A) that receive the fasteners such that sliding of the compression block and/or reduction guide over the fasteners rotates the metatarsal. 410 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In one embodiment, a compression block may include four holes one for each fastener of the first bone attachment feature 908 and the second bone attachment feature 910. These four holes may be parallel to each other as they extend through the compression block and may be aligned with each other longitudinally (e.g., along dorsal axis 1206). Consequently, as the compression block is slid down the fasteners, the fasteners of the second bone attachment feature 910 are aligned with the fasteners of the first bone attachment feature 908 along the longitudinal axis 1202 and/or the dorsal axis 1206. This alignment causes the metatarsal to rotate about its long axis, about longitudinal axis 1202, within the frontal plane. This rotation can correct a position of sesamoids of the metatarsal. The metatarsal rotates from a deformed position to a corrected position. 409 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 Advantageously, with the resection guide 820c removed, a surgeon may prepare the cut faces for a fusion and then proceed with a reduction of the bones and/or bone fragments. In one embodiment, the surgeon may slide a compression block (e.g., or a positioning guide or a reduction guide) over the fasteners used with the first bone attachment feature 908 and those used with the second bone attachment feature 910. Alternatively, or in addition, the surgeon may reduce the bones manually. 408 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 Next, the surgeon may slide the resection guide 820c off of the fasteners of one of the first bone attachment feature 908 and the second bone attachment feature 910. Next, the surgeon may slide the resection guide 820c off of the other one of the first bone attachment feature 908 and the second bone attachment feature 910. In certain embodiments, the size of angle A and/or the length of the fasteners may impede removal of the resection guide 820c by sliding off of the fasteners while the fasteners remain in the bone(s). In such embodiments, a surgeon may temporarily remove fasteners such as those in first bone attachment feature 908 to facilitate removal of the resection guide 820c and then replace the fasteners used in the first bone attachment feature 908 into the same holes in the bone they were in previously. 407 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In the illustrated embodiment, in one example surgical technique, a surgeon deploys a first pair of fasteners in first bone attachment feature 908 or second bone attachment feature 910 and a second pair of fasteners in the other one of the first bone attachment feature 908 or second bone attachment feature 910. Next, the surgeon forms a first osteotomy in a cuneiform or a metatarsal. Next, the surgeon forms a second osteotomy in the other one of the cuneiform or the metatarsal. 406 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In certain embodiments, the medial surface 1006 is a bone engagement surface configured to engage a lateral surface of the base of the metatarsal. In certain embodiments, the bone engagement surface of the medial surface 1006 may be defined based at least in part on a model of a metatarsal of a specific patient. When the resection guide 820c is in use and positioned in a desired position, the medial surface 1006 with its bone engagement surface may contact and/or engage with at least a portion of a lateral surface of the base of a metatarsal of the TMT joint. In this manner, the landmark registration feature 1004 facilitates engagement and placement of the resection guide 820c in a predetermined position. 357 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 FIG. 10C also illustrates details of the illustrated embodiment of the landmark registration feature 1004. In the illustrated embodiment, the landmark registration feature 1004 includes a medial surface 1006 and a lateral surface 1008. (See also FIGs. 10F and 10G). In one embodiment, the landmark registration feature 1004 may be configured to engage with a metatarsal of a patient. Specifically, the landmark registration feature 1004 may be configured to engage with a base of the metatarsal of a patient that is part of a TMT joint of a patient. Accordingly, the landmark registration feature 1004 may include a medial surface 1006 that is contoured to match a surface of at least a portion of a base of a metatarsal of the patient. 356 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In certain embodiments, the landmark registration feature 1004 may be referred to as a lateral metatarsal tab, at least in part because the landmark registration feature 1004 is configured to engage with a lateral surface of a base of a metatarsal. In another embodiment, the landmark registration feature 1004 may include a plurality of planes for additional surfaces of the landmark registration feature 1004. These planes can be oriented in a variety of directions and can be configured to be patient-specific surfaces, patient-matched surfaces, or the like. Advantageously, a landmark registration feature 1004 having a plurality of surfaces can enable fabrication of instrumentation (e.g., resection guides) that are further tailored, configured, and/or designed to meet the needs of a particular patient and/or user. 358 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In the illustrated embodiment, the landmark registration feature 1004 extends from the distal side 920 of the body 900. The position along the distal side 920 and the length and/or configuration of the landmark registration feature 1004 can be patient-specific and can be determined at least in part based on a bone model of one or more bones of a patient. In certain embodiments, the landmark registration feature 1004 may be referred to as a “met base arm” because it extends from the body 900 like an appendage towards a metatarsal of a patient. Those of skill in the art will appreciate that the landmark registration feature 1004 may not include a bone engagement surface on the medial surface 1006. Similarly, the resection guide 820c can include a plurality of landmark registration features. In such an embodiment, one or more landmark registration features 1004 may extend toward and/or engage with a cuneiform or other bone of a patient and/or one or more landmark registration features 1004 may extend toward and/or engage with a metatarsal or other bone of a patient. Alternatively, or in addition, a user such as a surgeon may request that a landmark registration feature 1004 be included in the resection guide 820c or may request that a landmark registration feature 1004 be omitted. Or a user may request one or more landmark registration features 1004 configured to engage other parts of one or more bones of a patient. 359 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 FIG. 10D is a distal side view of the resection guide 820c. FIG. 10D illustrates a profile view of a soft tissue displacement feature 1020. The soft tissue displacement feature 1020 moves and/or holds soft tissue in a displaced condition/state while the resection guide 820c is in use. In one embodiment, the soft tissue displacement feature 1020 engages soft tissue that is adjacent to one or more bones when the resection guide 820c is in use. Those of skill in the art will appreciate that the soft tissue displacement feature 1020 can be simple or complex. Furthermore, the configuration of the soft tissue displacement feature 1020 can be based on specific soft tissue the soft tissue displacement feature 1020 is intended to engage, hold/retain, and/or displace. 360 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In certain embodiments, the soft tissue displacement feature 1020 can simply be a surface of a side of the body 900 (e.g., lateral side 924). In other embodiments, the soft tissue displacement feature 1020 can include a recess, slot, or channel configured to engage with the soft tissue when the resection guide 820c is in use. In one embodiment, the soft tissue displacement feature 1020 is configured to engage with the soft tissue and/or displace the soft tissue while not damaging the soft tissue, or at least mitigating damage to the soft tissue. 361 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In the illustrated embodiment, the soft tissue displacement feature 1020 includes a superior protrusion 1022 and an inferior protrusion 1024. Those of skill in the art will appreciate that the soft tissue displacement feature 1020 may include the superior protrusion 1022, the inferior protrusion 1024, or both. The superior protrusion 1022 and/or inferior protrusion 1024 may also be referred to as lips and/or tabs. 362 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 The superior protrusion 1022 and/or inferior protrusion 1024 guide and/or retain a specific soft tissue in a particular location during use of the resection guide 820c. In the illustrated embodiment, the particular location may be a part of the lateral side 924 between the superior protrusion 1022 and the inferior protrusion 1024. In the illustrated embodiment, the specific tissue may be an Extensor Hallucis Longus (EHL) tendon which typically extends from the extensor hallucis longus muscle towards the big toe, hallux. 363 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In one embodiment, the superior protrusion 1022 may have a planar superior surface and a sloped inferior surface. The planar superior surface may also serve as a handle and/or finger position for a user as a user positions the resection guide 820c during use. The sloped inferior surface can facilitate displacement of the soft tissue towards the lateral side 924 between the superior protrusion 1022 and inferior protrusion 1024. The superior protrusion 1022 may extend two to three times further laterally from the body 900 than the inferior protrusion 1024. 364 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 The inferior protrusion 1024 can include a sloped superior surface and a sloped inferior surface. The sloped superior surface can facilitate displacement of the soft tissue towards the lateral side 924 between the superior protrusion 1022 and inferior protrusion 1024. The sloped inferior surface can mitigate damage to other soft tissue while the resection guide 820c is in use. 365 Added by DJM Jan 2024 1/3/24, 4:24 AM

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