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Delete 		PER-16 Referring to FIG. 15C, in one embodiment, in contrast, the pivoting resection guide 1502b may be configured to resect a distal end (e.g., an articular surface) of the medial cuneiform 202 at an angle relative to a long axis of the first metatarsal 208 and/or one or more planes of the foot such that an orientation of first toe changes to a corrected position when the resected first metatarsal 208 is fused with the medial cuneiform 202. Consequently, the cutter guide 1510 may extend from the first bone attachment feature 1506 in a direction and at an orientation such that pivoting the cutter guide 1510 about the pivot axis 1014 will result in resection of the medial cuneiform 202 at a desired angle. In one embodiment, the angle of the resection is in a sagittal plane and a transverse plane of the foot. Advantageously, both the pivoting resection guide 1502a and the pivoting resection guide 1502b may remain on the surface of the skin of the foot while anchored in position. The cutting tool 1526 may enter through a small poke incision and the resection may be conducted percutaneously. In this manner, a Lapidus procedure on a TMT joint may be minimally invasive. 318 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 There are many ways to make cuts of the medial cuneiform 202 and the first metatarsal 208 to produce a correction. In one embodiment, the first metatarsal 208 can be cut perpendicular to the long axis of the first metatarsal 208 and the cut of the medial cuneiform 202 can be angled in one or more planes. In another embodiment, the medial cuneiform 202 can be cut perpendicular to a long axis of a toe (e.g. a desired corrected position of the first metatarsal 208) of the patient and the cut of the first metatarsal 208 can be angled in one or more planes. Alternatively, or in addition, both a cut of the first metatarsal 208 and the medial cuneiform 202 may be angled in one or more planes such that when both bones are fused together at the newly formed cut faces a desired orientation of the bones is achieved. 327 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Next, a surgeon may remove the proximal pin (e.g., the fastener 1516 anchored in the medial cuneiform 202) and remove the pivoting resection guide 1502a. The distal fastener 1516 can remain in the first metatarsal 208. 326 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Next, a surgeon slides a first pivoting resection guide 1502a over the fasteners 1516 and down against the skin. (See FIG. 16B) Next, the surgeon resects a bone aligned with a longitudinal axis 1302 of the cutting tool 1526 (e.g., the first metatarsal 208). In this manner, a cut perpendicular to the long axis of the first metatarsal 208 is made. 325 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 With the pin positioner 1602 in a desired position, the surgeon deploys one or more fasteners 1516 through openings in the arms 1606. These fasteners 1516 serve as anchors for positioning one or more pivoting resection guides 1502. In the illustrated embodiment, the fasteners 1516 may be inserted perpendicular to a long axis of the first metatarsal 208. One fastener 1516 is anchored in the medial cuneiform 202 and the other in the first metatarsal 208. 324 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In another embodiment, the arms 1606 may remain above a skin surface as the probe 1604 enters and/or contacts a joint. In one embodiment, a patient facing surface of the arms 1606 may register with skin of the patient. 323 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In one embodiment, the pin positioner 1602 includes one or more arms 1606 that include openings for placement and/or orientation of pins or fasteners 1516. The arms 1606 can pass through an incision in the skin and rest on one or more bones of the patient. In such an embodiment, the arms 1606 may include a bone contacting surfaces that is a bone engagement surface. 322 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIG. 16A-16C illustrate views a method 1600 for performing an osteotomy using an example pivot resection guide that includes a pin positioner 1602 and one or more pivoting resection guides 1502a,b. First, a surgeon may make a pock hole or stab incision in the skin at a TMT joint. Next, a surgeon inserts a probe 1604 at a distal end of the pin positioner 1602. The probe 1604 may be configured to register with landmarks on, around, or in the TMT joint. In one embodiment, the probe 1604 includes patient-specific features and/or surfaces to facilitate positioning the probe 1604 within or on the TMT in a desired position. For example, the probe 1604 may include one or more surfaces that are contoured to engage inverse but corresponding surfaces of one or more bones or openings within a TMT joint. In certain embodiments, a surgeon moves the pin positioner 1602 until the probe 1604 seats in a desired position within the TMT. A surgeon may be able to feel when the pin positioner 1602 moves to the desired position and registers with the bone(s) and/or joint. 321 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In one embodiment, the design of the pivoting resection guide 1502 enables faster and more efficient fabrication of the pivoting resection guide 1502. For example, because the parts of the pivoting resection guide 1502 will be fit together when assembled, the fabrication of the first bone attachment feature 1506, the second bone attachment feature 1508, and the cutter guide 1510 can be made in a single session. For example, with an additive manufacturing tool such as a 3D printer, each of these parts can be fabricated in one session with proper clearances and separation between the parts. This can greatly reduce fabrication time. 320 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIG. 15D illustrates one example of a pivoting resection guide 1502 in an exploded view. In this embodiment, the cutter guide 1510 may have a barrel shape that includes two opposing arms 1528. One or more of the arms 1528 may include a recess or groove 1530. When assembled, an arm 1528 may fit within opening 1532 of the first bone attachment feature 1506 and/or second bone attachment feature 1508. The pivoting resection guide 1502 includes one or more fasteners 1516 in the form of pins that fit within opening 1534. The fasteners 1516 is configured to slide within the opening 1534 and the fasteners 1516 fits within the groove 1530 to provide an interference fit and lock the arms 1528 within the opening 1532. In one embodiment, the cutter guide 1510 includes an opening that extends from one end to the other end. The opening may include internal threads configured to engage threads of a handle (not shown in FIG. 15D). 319 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Referring still to FIG. 12A, in one embodiment, the first coupler 1118 includes a proximal arm 1230, a proximal arm groove 1232, and a proximal arm retainer 1234. The proximal arm 1230 extends from a first side of the cutter guide 1010 at a first arm angle 1236 towards the first bone attachment feature 1006. In the illustrated embodiment, the proximal arm 1230 is a cylindrical structure that extends from the cutter guide 1010. The opening 1226 is also circular which allows the proximal arm 1230 to rotate within the opening 1226. 289 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIG. 15B illustrates a pivoting resection guide 1502a positioned for resecting a first bone and FIG. 15C illustrates a pivoting resection guide 1502b positioned for resecting a second bone. In certain embodiments, the pivoting resection guide 1502a and pivoting resection guide 1502b may differ from each other in order to make a desired resection at a desired angle relative to one or more planes of a foot and/or axis of a toe or joint. In FIG. 15B, the pivoting resection guide 1502a is configured to resect a proximal end of a first metatarsal 208 and at a predetermined angle that may be patient-specific. For example, the cutter guide 1510 may pivot about a pivot axis 1014 (See FIG. 15D) that is perpendicular to a longitudinal axis 1302 of the cutter guide 1510 and the cutting tool 1526 deployed within the cutter guide 1510. The pivoting resection guide 1502a may be configured such that the longitudinal axis 1302 is perpendicular to a long axis of the first metatarsal 208. 317 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In one embodiment, the pivoting resection guide 1502 may include a single first bone attachment feature 1506 that enables the pivoting resection guide 1502 to pivot about a long axis of a single fastener deployed within the first bone attachment feature 1506. Such an embodiment may be used to enable a cutter tool to form an arc shaped resection about the single fastener deployed within the first bone attachment feature 1506. 316 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIGS. 15A-15D illustrate views of an example pivot resection guide, according to one embodiment. FIG. 15A illustrates an alternative embodiment of an osteotomy system 1500 for a Lapidus surgical procedure of a foot. Specifically, the surgical procedure is a minimally invasive procedure Lapidus procedure. FIGS. 15A-15D illustrate views of an alternative embodiment of an osteotomy system 1000. The pivoting resection guide 1502 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-14B, like parts are identified with the same or similarly numbered reference numerals. Accordingly, the osteotomy system 1500 may include a pivoting resection guide 1502 that includes a first bone attachment feature 1506 and a second bone attachment feature 1508 with a cutter guide 1510 between them that is configured to accept a cutting tool 1526. As with the pivoting resection guide 1002, the first bone attachment feature 1506 and/or second bone attachment feature 1508 may include holes configured to receive fasteners 1516. The cutter guide 1510 is configured to receive a cutting tool 1526 that will perform the resection or dissection. 315 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIG. 14A is a perspective view of a resection guide in one example pivot position and secured to a bone. FIG. 14A illustrates the osteotomy system 1000 deployed on a medial side and towards a distal end of the first metatarsal 208. In the illustrated embodiment, the cutting tool 1026 is deployed in the cutter guide 1010 and the distal end 1204 is near the plantar cortex of the first metatarsal 208. As a user moves the proximal end 1202 plantarly in direction 1030, the distal end 1204 moves dorsally and contacts and begins cutting the first metatarsal 208. FIG. 14B is a perspective view of a resection guide in another example pivot position and secured to a bone. In the illustrated embodiment, the cutting tool 1026 is deployed in the cutter guide 1010 and the distal end 1204 is approaching the dorsal cortex of the first metatarsal 208. As a user moves the proximal end 1202 plantarly in direction 1028, the distal end 1204 moves plantarly and contacts and begins cutting the first metatarsal 208. 314 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIG. 13B is a side view of the resection guide, according to one embodiment, in another pivot position. With the cutter guide 1010 in the position illustrated in FIG. 13B, a user may apply an effort force (FE) to the handle 1004 clockwise in direction 1030 (e.g., dorsally) and the lever pivots about pivot axis 1014. As the cutter guide 1010 pivots about the pivot axis 1014, the distal end of the cutting tool 1026 moves clockwise in direction 1030 (e.g., dorsally) and removes parts of a bone 1304. 313 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIGs 13A and 13B illustrate an example of the pivoting resection guide 1002 as a first-class lever in action. The example illustrates the pivoting resection guide 1002 attached to a medial side of bone 1304. The handle 1004 is moved counterclockwise direction 1028 (e.g., dorsally) and the lever pivots about pivot axis 1014. As the cutter guide 1010 pivots about the pivot axis 1014, the distal end of the cutting tool 1026 moves counterclockwise in direction 1030 (e.g., plantarly) and removes parts of a bone 1304. By operating the cutting tool 1026 and pivoting the cutting tool 1026 within the cutter guide 1010, a user can dissect or resect the bone 1304 in the path of the cutting section 1222 of the cutting tool 1026 between the first bone attachment feature 1006 and the second bone attachment feature 1008. 312 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 The pivot axis 1014 serves as, or as part of a fulcrum for the first-class lever of the pivoting resection guide 1002. The magnitude of the load force (FL) is the effort force (FE) multiplied by the length of the lever arm 1306. The lever arm 1306 is a distance between the fulcrum (e.g., pivot axis 1014) and a point toward the proximal handle end 1210 where the effort force (FE) is applied (e.g., by a user). 311 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Advantageously, the first-class lever formed by, and using, the pivoting resection guide 1002 magnifies the FL that is applied to the bone 1304. Consequently, resection/dissection of the bone 1304 requires less effort, less FE. In this manner, the pivoting resection guide 1002 facilitates resection/dissection of harder and/or more dense bone, such as that of the cortex of the bone 1304. 310 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIG. 11E illustrates that the first height 1120 and the second height 1122 are defined such that the trajectory 1124 of the cutter guide 1010 extends substantially perpendicular to the longitudinal axis 1154 of at least one of the bones that is to be resected/dissected using the pivoting resection guide 1002. In one example, the longitudinal axis 1154 may be a long axis of a first metatarsal 208. In certain embodiments, the first height 1120 and second height 1122 may be of the same or substantially the same magnitude. The size of the first height 1120 and/or second height 1122 can vary depending on the contour of a bone surface that contacts the first bone attachment feature 1006 and second bone attachment feature 1008, the first angle 1150, the second angle 1152, an angle of the opening 1116, an angle of the opening 1146, whether the pivoting resection guide 1002 will span a joint and involve two bones, and the like. Advantageously, each of these aspects can be accounted for and accommodated when models of the bones of the patient and/or models of instruments such as the osteotomy system 1000 are reviewed and defined during preoperative planning stages in accordance with the present disclosure. 278 Added by DJM Jan 2024 1/3/24, 4:26 AM

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