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Delete 		PER-16 FIG. 18A illustrates a cutting tool 1026a that is configured to mitigate, eliminate, and/or avoid contact between the cutting section 1222 and the cutter guide 1010 (e.g., the walls of opening 1206). In the illustrated embodiment, the cutting tool 1026a includes a cutting section 1222 with a first diameter D1 and the guide section 1224 has a second diameter D2. In one embodiment, the first diameter D1 is smaller than the second diameter D2. The size of the second diameter D2 may be just large enough to permit a close fit between a section of the cutting tool 1026 with the second diameter D2 (e.g., the guide section 1224) and the wall of the opening 1206 of the cutter guide 1010. In this manner, the cutting section 1222 substantially avoids contact with the wall of the opening 1206 of the cutter guide 1010. 333 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIG. 18B illustrates an alternative embodiment of cutting tool 1026b that is configured to mitigate, eliminate, and/or avoid contact between the cutting section 1222 and the cutter guide 1010 (e.g., the walls of opening 1206). In the illustrated embodiment, the cutting tool 1026b includes collar 1254 between the cutting section 1222 and the drive section 1220. As with the larger diameter D2, the collar has a diameter that permits a close fit between the collar 1254 and the wall of the opening 1206 of the cutter guide 1010. In this manner, the cutting section 1222 substantially avoids contact with the wall of the opening 1206 of the cutter guide 1010. 334 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 The cuneiform cutter guide 1910 is configured to guide the cutting tool 1926 for resection/dissection of the medial cuneiform 202. Those of skill in the art will appreciate that varies aspects of the cuneiform cutter guide 1910 can be defined such that operation of the cutting tool 1926 by way of cuneiform cutter guide 1910 forms an osteotomy of a predefined trajectory in the medial cuneiform 202 of the patient. Examples of these aspects include but are not limited to a length of the proximal arm 1230, a length of the distal arm 1238, a size of the first arm angle 1236, a size of the second arm angle 1244 and the like. 348 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Similarly, referring to FIG. 18B, the collar 1254 may be configured such that a distal end 1256 closer to the distal end 1204 of the cutting tool 1026 has a small enough diameter to fit within the opening 1206 and a proximal end 1258 closer to the proximal end 1202 has a larger diameter that will not fit within the opening 1206. The length between the distal end 1256 and the proximal end 1258 can be relatively short or can be longer. In certain embodiments, this length may be patient-specific. In this manner, a collar 1254 can be used as a depth stop for the cutting tool 1026. 336 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIGS. 19A-19B illustrate views of an exemplary system 1900, according to one embodiment. FIGS. 19A-19B illustrate an alternative embodiment of an osteotomy system 1900 for a Lapidus surgical procedure of a foot. FIGS. 19A-19B illustrate views of an alternative embodiment of an osteotomy system 1000. The pivoting resection guide 1902 may have many structures, features, and functions, operations, and configuration similar or identical to those of the pivoting resection guide 1002 described in relation to FIGS. 10A-18B, like parts are identified with the same or similarly numbered reference numerals. Accordingly, the osteotomy system 1900 may include a pivoting resection guide 1902 that includes a cuneiform attachment feature 1906 and a first metatarsal attachment feature 1908. 337 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Referring now to FIGS. 18A and 18B, in certain embodiments, a cutting tool 1026 can be configured to control a depth that the cutting tool 1026 can be inserted into the opening 1206. In one embodiment, a section along the length of the cutting tool 1026 may start out with a diameter D2 which fits within the cutting tool 1026 and gradually increase at some point between the guide section 1224 and the proximal end 1202 such that at some point the cutting tool 1026 can move no further into the opening 1206. In this manner, the depth of insertion of the cutting tool 1026 can be controlled. In certain embodiments, this depth may be patient-specific and/or may be predetermined or requested by a surgeon for a particular surgical procedure. 335 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIGS. 18A-18C illustrate views of example cutting tools that can be used, according to different embodiments. In one embodiment, the cutting tool 1026a has an elongate body with a round cross section. The drive section 1220 is near the proximal end 1202 and is configured to couple to a driver that rotates the cutting tool 1026. The guide section 1224 engages with the pivoting resection guide 1002 and guides the cutting tool 1026 during the creation of an osteotomy. The cutting section 1222 is near the distal end 1204. The cutting section 1222 is the part that resects/dissects the bone to form an osteotomy. In one embodiment, the cutting section 1222 includes a set of flutes or grooves that include sharp edges configured to cut and resect hard tissue and/or soft tissue. 332 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIGS. 17A-17B illustrate views performing an osteotomy using an example pivot resection guide on a calcaneus bone, according to one embodiment. Those of skill in the art will appreciate that the example pivoting resection guide 1002 and/or pivoting resection guide 1502 are simply examples and that a pivoting resection guide can be used for a variety of osteotomies on a variety of bones. As another example, a pivoting resection guide can be used for resection of a calcaneus 224. Alternatively, or in addition, pivoting resection guide can be used for resection of a femur, a humerus, a radius, an ulna, a phalange, a phalanx, or other bone of a person or animal. FIG. 17A illustrates an osteotomy system 1700 that includes a pivoting resection guide 1702 for use in resecting a calcaneus 224. In one embodiment, the pivoting resection guide 1702 may include patient-specific features. In another embodiment, the pivoting resection guide 1702 does not include patient-specific features. FIG. 17B illustrates superior perspective view of an osteotomy system 1700 that includes a pivoting resection guide 1702 for use in resecting a calcaneus 224. The calcaneus 224 is shown in transparent form. 331 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Continuing with the method 1600, next a surgeon may deploy a fastener 1516 into the medial cuneiform 202 at an angle and orientation other than perpendicular to a surface of the bone. Next, a surgeon slides a second pivoting resection guide 1502b over the deployed fasteners (e.g., fastener 1516 and fastener 1516). Next, the surgeon deploys the cutting tool 1526 and resects the medial cuneiform 202. Finally, the surgeon brings the newly cut face of the first metatarsal 208 against the medial cuneiform 202 and fixates the two together for subsequent healing and recovery. In certain embodiments, the surgeon may rotate the first metatarsal 208 prior to fixation to further provide desired correction. Then method 1600 ends. Advantageously, the method 1600 can provide a minimally invasive procedure where the arms 1606 of the pin positioner 1602 remain above the skin. In such an embodiment, the procedure may be performed using three small incisions. 330 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Alternatively, the holes of the first bone attachment feature 1506 and/or second bone attachment feature 1508 can engage the fasteners 1516 at an angle and/or orientation that will cause the cutting tool 1526 to resect a bone at a desired angle. FIG. 16B and 16C illustrate such an embodiment. Fastener 1516 may enter the medial cuneiform 202 at an angle different a fastener 1516 in a first metatarsal 208, such that cutting tool 1526 will resect the medial cuneiform 202 at an angle within one or more planes such that joining the medial cuneiform 202 and the first metatarsal 208 will provide a desired toe orientation correction. 329 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 The osteotomy system 1900 includes both a cuneiform cutter guide 1910 and a first metatarsal cutter guide 1912. Both the cuneiform cutter guide 1910 and the first metatarsal cutter guide 1912 are configured to couple to the cuneiform cutter guide 1910 or the first metatarsal cutter guide 1912 between the cuneiform attachment feature 1906 and a first metatarsal attachment feature 1908. In addition, each of the cuneiform cutter guide 1910 and a first metatarsal cutter guide 1912 may be configured to accept a cutting tool 1926. Alternatively, or in addition, each of the cuneiform cutter guide 1910 and a first metatarsal cutter guide 1912 may be configured to accept a different cutting tool 1926. 338 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 As with the pivoting resection guide 1002, the cuneiform attachment feature 1906 and/or first metatarsal attachment feature 1908, in certain embodiments, include holes configured to receive fasteners. The cuneiform attachment feature 1906 is configured to receive a cuneiform fastener 1914 and the first metatarsal attachment feature 1908 is configured to receive a metatarsal fastener 1916. The cuneiform fastener 1914 is configured to engage a medial cuneiform 202. The metatarsal fastener 1916 is configured to engage a first metatarsal 208. 339 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Advantageously, the pivoting resection guide 1902 is configured to resect both the medial cuneiform 202 and the first metatarsal 208. The cuneiform cutter guide 1910 is configured to be removably coupled between the cuneiform attachment feature 1906 and the first metatarsal attachment feature 1908. The cuneiform cutter guide 1910 is configured to guide a cutting tool, such as cutting tool 1926, as the cutter guide pivots about a pivot axis 1014 that extends between the cuneiform attachment feature 1906 and the first metatarsal attachment feature 1908. Similarly, the first metatarsal cutter guide 1912 is configured to be removably coupled between the cuneiform attachment feature 1906 and the first metatarsal attachment feature 1908. The first metatarsal cutter guide 1912 is configured to guide a cutting tool, such as cutting tool 1926, as the first metatarsal cutter guide 1912 pivots about the pivot axis 1014 that extends between the cuneiform attachment feature 1906 and the first metatarsal attachment feature 1908. 340 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In the illustrated embodiment, the cutting tool 1926 has an elongate body with a proximal end and distal end. The cutting tool 1926 also includes a drive section 1220 near the proximal end, a cutting section 1222 near the distal end, and guide section 1224 between the drive section 1220 and the cutting section 1222. The cutting tool 1926 is configured to be deployed within an opening (e.g., opening 1206) in one of the cuneiform cutter guide 1910 and the first metatarsal cutter guide 1912. 341 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In one embodiment, the osteotomy system 1900 may also include a handle (not shown in FIG. 19). The handle may be substantially similar to the handle 1004 described herein. In such an embodiment, the handle may include a distal handle end that includes a handle coupler (e.g., handle coupler 1212). The handle coupler 1212 is configured to engage with one of the cuneiform cutter guide 1910 and the first metatarsal cutter guide 1912. The handle also includes a proximal handle end opposite the distal handle end and an opening that extends from the proximal handle end to the distal handle end and is coaxial with a longitudinal axis of the handle. 342 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In embodiments of the osteotomy system 1900 that include a handle, as well as those that do not include a handle, the pivoting resection guide 1902 combines the cutting tool 1926, a cutter guide (either cuneiform cutter guide 1910 or first metatarsal cutter guide 1912) and the cuneiform attachment feature 1906 and first metatarsal attachment feature 1908 to for a first-class lever that magnifies a load force applied to a bone in contact with the cutting tool 1926 near the distal end of the cutting tool 1926 based on an effort force applied by a user near a proximal end of the cutting tool 1926. 343 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Where the osteotomy system 1900 includes a handle, the handle is configured to pass the cutting tool through the opening and couple to one of the cuneiform cutter guide 1906 and the first metatarsal cutter guide 1908 to form the first-class lever. In such an embodiment, the effort force may be applied by a user near the proximal end of the handle. 344 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Referring now to FIGS. 19A, 19B, and 12A, in the illustrated embodiment, the cuneiform cutter guide 1910 and first metatarsal cutter guide 1912 have many, if not all, of the same or similar structures, features, and functions, operations, and configuration similar or identical to those of the example cutter guide 1010 described in relation to FIG. 12A, like parts are identified with the same or similarly numbered reference numerals. 345 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Referring now to FIG. 19B, the cuneiform cutter guide 1910 is illustrated decoupled from the pivoting resection guide 1902. Suppose the cuneiform cutter guide 1910 has the same configuration as cutter guide 1010. Accordingly, the cuneiform cutter guide 1910 includes a proximal arm 1230 that extends from a first side of the cuneiform cutter guide 1910 at a first arm angle 1236 towards the cuneiform attachment feature 1906 and a proximal arm groove 1232 toward a distal end of the proximal arm 1230. The cuneiform cutter guide 1910 also includes a proximal arm retainer 1234 (which in the illustrated embodiment is a toolless coupler, such as a thumbscrew). Notably the proximal arm retainer 1234 is configured to be operated by a user to releasably engage with the proximal arm 1230. 346 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Similarly, the cuneiform cutter guide 1910 includes a distal arm 1238 that extends from a second side of the cuneiform cutter guide 1910 at a second arm angle 1244 towards the first metatarsal attachment feature 1908 and a distal arm groove 1240 toward a distal end of the distal arm 1238. The cuneiform cutter guide 1910 also includes a distal arm retainer 1242 (which in the illustrated embodiment is a toolless coupler, such as a thumbscrew). Notably the distal arm retainer 1242 is configured to be operated by a user to releasably engage with the distal arm 1238. 347 Added by DJM Jan 2024 1/3/24, 4:26 AM

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