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Delete 		TMC-PAT-4 Those of skill in the art will appreciate that instead of an opening 838, a resection guide 820a, 820b, 820c may include one or more holes in the body 900 sized to accept one or more pins or K-wires. The holes in the body 900 can be strategically positioned such that with the resection guide in a desired position, K-wires or pins that are deployed through the holes indicate trajectories for one or more bones involved in the surgical procedure. These K-wires/pins may extend through the body 900 parallel to a longitudinal axis of a cuneiform bone and/or a metatarsal. These K-wires/pins may be used to check a position of a resection guide in relation to a longitudinal axis of one or more of the bones. A surgeon may deploy and use K-wires/pins passing through the body 900 to check positions and/or alignments before completing the surgical procedure. Alternatively, or in addition, the K-wires or pins that deployed through the holes may indicate trajectories for where longitudinal axes of the one or more bones will be after the surgical procedure. Thus, in certain embodiments, holes in the body 900 and K-wires/pins passing through the holes may be used to check position and/or trajectories before an osteotomy and/or holes in the body 900 and K-wires/pins passing through the holes may be used to check position and/or trajectories for where bones will be postoperatively. 343 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 FIGS. 10A-10F illustrate views of resection guide 820c. The resection guide 820c may have many structures, features, and functions, operations, and/or configuration similar or identical to those of the resection guide 820b described in relation to FIGS. 7-9F, like parts are identified with the same reference numerals. Accordingly, the resection guide 820c may include one or more resection features 902, 904, a window 906, a first bone attachment feature 908 or set of proximal openings, a second bone attachment feature 910 or set of distal openings, a bone engagement feature 912 that can include one or more bone engagement surfaces 944, one or more landmark registration features, and the like. The resection guide 820c may include a body 900, a superior side 914, an inferior side 916, a proximal side 918, a distal side 920, a medial side 922, and/or a lateral side 924. And embodiments of the resection guide 820c may include an anchor feature 942 and one or more markings 970. As with the resection features 722 of other embodiments of resection guide 720, the resection features 722a,b can include an open end 729 and a closed end 731. 344 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In addition, the resection guide 820c may have a different design and/or configuration than the resection guide 820b. For example, the size, shape, and/or design of the body 900 may be different. Furthermore, certain features of the resection guide 820c may be different from the resection guide 820b. 345 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In the illustrated embodiment, the body 900 connects the proximal resection feature 902 to the distal resection feature 904. Alternatively, or in addition, the body 900 also connects to the first bone attachment feature 908 and the second bone attachment feature 910. 346 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In the illustrated embodiment, the body 900 connects to the first bone attachment feature 908 by way of a connector 1002a or coupler 1002. Alternatively, or in addition, the body 900 may include a body 900 that connects to the second bone attachment feature 910 by way of a connector 1002b or coupler 1002. The connectors 1002 may be a part of the body 900 or separate components. The connector 1002a is between the first bone attachment feature 908 and the proximal resection feature 902. The connector 1002b is between the second bone attachment feature 910 and the distal resection feature 904. 347 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In the illustrated embodiment, the bone attachment features, connectors, and/or size and shape of the body can be optimized to use enough material such as biocompatible materials (e.g., titanium) to provide the required strength and structural integrity, while minimizing the amount of material used to fabricate the resection guide 820c. Such optimizations can result in the use of connectors in place of using a larger main body portion of the body. Furthermore, the length, width, and height of the body 900 may be optimized to use the least amount of material and still provide the desired level of structural strength and integrity. 348 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In certain embodiments, a user may provide user instructions that affect the size, shape, and/or configuration of the body 900, the connectors, bone attachment features, anchors, and/or landmark registration features. For example, the user may wish to make the body 900 as small and narrow as possible. A larger resection guide 820c may require larger incisions which could lead to longer recovery times for a patient. However, the smaller the body 900, the less surface area of a patient-specific bone engagement feature, such as a bone engagement surface on a bone facing side of the resection guide 820c. The smaller patient-specific bone engagement feature may make positioning the resection guide 820b in a predetermined position more challenging. Thus, the user (e.g., surgeon) may weigh the benefits and challenges in the trade-off between the size and shape of the body 900 and corresponding size of a patient-specific bone engagement feature versus the ease of positioning the resection guide 820b during the surgical procedure. Those of skill in the art will appreciate that the resection guide 820c can have a variety of features, configurations, sizes and/or attributes that can be based at least in part on needs or preferences of patients, the nature of the deformity, and/or surgeon preferences. 349 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 FIG. 10A is a proximal perspective view of the resection guide 820c. FIG. 10A illustrates that the first bone attachment feature 908 is offset relative to the second bone attachment feature 910, these bone attachment features are not aligned along a longitudinal axis of the resection guide 820c, in certain embodiments. In certain embodiments, the alignment or nonalignment of the bone attachment features may be due patient-specific needs, a preoperative plan, surgeon preferences, or the like. 350 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 FIG. 10B is a superior view of the resection guide 820c. FIG. 10B illustrates a first bone attachment feature 908 that extends from the proximal side 918 and a second bone attachment feature 910 that extends from the distal side 920. FIG. 10B also illustrates a landmark registration feature 1004 that extends from the distal side 920. In one embodiment, the landmark registration feature 1004 is distinct from the landmark registration feature 1004 of other embodiments. In another embodiment, the landmark registration feature 1004 may be similar to the landmark registration feature 1004 of other embodiments. 351 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 FIG. 10B also illustrates bone attachment features 908, 910. Certain bone attachment features may be positioned to engage with a resected segment, wedge, or bone fragment and other bone attachment features may engage with remaining bones or bone segments after resection. Furthermore, the resection guide 820c may include bone attachment features that are strategically positioned in the resection guide 820c to serve as trajectory guides, attachment points, compression anchors, distraction anchors, reduction guides or the like. For example, bone attachment features 908, 910 and the pins or fasteners deployed in holes of the bone attachment features 908, 910 can be strategically placed in a way that following the osteotomies, the fasteners/pins can then be manipulated to aid in the reduction/correction of the osteotomies either manually and/or using specialized instrumentation and/or customized instrumentation or compression blocks. 352 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In addition, the bone attachment features and associated fasteners (e.g., pins) can be designed, positioned, oriented, and utilized to target provisional and/or permanent fixation devices such as pins, staples (using holes formed by the fasteners), screws, bolts, beams, nail or strategically placed reduction wires that can be utilized for external devices such as external fixators. Furthermore, customized guides can be placed over strategically placed fasteners used with bone attachment features and these fasteners can be used for the purposes of pre-drilling fixation components or features of implants such as for screws or strategic placement of fixation, plates, staples, etc. 353 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 FIG. 10C is an inferior view of the resection guide 820c. FIG. 10B illustrates a bone engagement feature 912. The bone engagement feature 912, in this embodiment, includes a bone engagement surface 944b near the proximal end 824 and a bone engagement surface 944a near the distal end 826. FIG. 10B also illustrates that the size and shape of the body 900 have been configured to provide a sufficient size for the bone engagement surface 944a and/or bone engagement surface 944b for registration with one or more bones of a patient. However, the size and shape of the body 900 may be no larger than needed for accurate registration and strength of the guide and of a minimal size and shape. 354 Added by DJM Jan 2024 1/3/24, 4:24 AM
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Delete 		TMC-PAT-4 In certain embodiments, the bone engagement feature 912 can include a plurality of sections such as bone engagement surface 944a and/or bone engagement surface 944b. In certain embodiments, each of these bone engagement surfaces together or separately can be specifically configured based on the patient anatomy, surface topography, and/or surgeon preferences to facilitate positioning and/or placement of the resection guide 820c. In one embodiment, one bone engagement surface can have a different level of detail and/or fidelity than others. In certain embodiments, parts of the inferior side 916 may include a depression, opening, and/or void that is sized to not contact the bone of a patient and instead provides clearance for desired positioning of the resection guide 820c. This can be helpful in reducing the complexity and/or fabrication costs for the resection guide 820c. 355 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 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 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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