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Delete 		PER-16 Advantageously, the system 900 can help a surgeon overcome one or more of the challenges in performing an osteotomy procedure, particularly on bones of a hand or of a foot of a patient, such as on the forefoot, midfoot, or hindfoot. One challenge during an osteotomy procedure can be maintaining control of, and/or position, and/or orientation of a bone, one or more bones, and/or bone pieces/fragments, particularly once a resection or dissection is performed. Advantageously, the fasteners 910, resection guide(s) 920, and/or complementary components 930 can be configured to assist in overcoming this challenge. 233 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Advantageously, the system 900 can help a surgeon in positioning, placing, and/or orienting a resection guide accurately. Modern techniques may include preoperative planning, simulation, or even practice using computer models, 3D printed models, virtual reality systems, augmented reality systems or the like. However, simulations and models are still different from actually positioning a resection guide on a patient’s bone, joint, or body part during the procedure. The system 900 can include a number of features, including patient-specific features, to assist the surgeon with the positioning. In one embodiment, the resection guide 920 can include one or more landmark registration features 928. 234 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Advantageously, the system 900 can help a surgeon in securing guides of the osteotomy system 900, such as a resection guide, as well as how to readily remove the guide (e.g., resection guide) without disturbing a reduction, shifting, reorienting, or repositioning one or more bones or parts of bones while removing the guide. In certain embodiments, the system 900 is configured to permit removal of a guide while keeping temporary fasteners in place for use in subsequent steps of an osteotomy procedure. Alternatively, or in addition, the system 900 may facilitate positioning of temporary fasteners during one step of a wedge osteotomy procedure for use in a subsequent step of the wedge osteotomy procedure. Removal of a guide during an osteotomy procedure can be particularly challenging where translation and/or rotation of the bones involved in the osteotomy procedure is required for the success of the osteotomy procedure. Advantageously, the system 900 accommodates translation and/or rotation of the bones during the osteotomy procedure while facilitating a successful outcome for the osteotomy procedure. 235 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Advantageously, the components of the system 900 can be specifically designed for a particular patient. Alternatively, or in addition, the components of the system 900 can be specifically designed for a class of patients. Each of the components of the system 900 can be designed, adapted, engineered and/or manufactured such that each feature, attribute, or aspect of the component is specifically designed to address one or more specific indications present in a patient. Advantageously, the cuts made for the osteotomy procedure can be of a size, position, orientation, and/or angle that provides an optimal osteotomy with minimal risk of undesirable resection. In one embodiment, the components of the system 900 can be configured such that an osteotomy is performed that enables a correction in more than one plane in relation to the parts of the body of the patient. For example, cut channels or resection features 922 in a resection guide 920 can be oriented and configured such that when the bones are fused/fixated the correction results from translation, rotation, and/or movement of bones or bone parts in two or more planes (e.g., sagittal and transverse) once the fragments or bones are reduced. 236 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In certain embodiments, the exemplary system 900 may include a plurality of fasteners 910, resection guides 920, and/or complementary components 930. For example, a surgeon may plan to resect a plurality of osteotomies from the bone(s) in order to accomplish a desired correction. In one example, one or more wedge segments may be resected from a medial side of a patient's foot and another one or more wedge segments may be resected from a lateral side of the patient's foot. These wedge segments may extend part way into the foot, or through from one side of the foot to the other. Of course, multiple wedge segments may be formed on one side of the foot as well. 237 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Additionally, a surgeon may use one or more components in an exemplary system 900 to make multiple cuts in the bone(s). The multiple cuts may be centered over or around an apex of a deformity or positioned at other locations within the foot such that when the multiple cuts are made, any resected segments removed, or added bone void fillers introduced, and/or bones and/or bone fragments translated and/or rotated the combined angles, surfaces, removed segments, and/or added portions cooperate to provide a desired correction. Each of the components of the exemplary system 900 can be identified, defined, and reviewed using the apparatuses, systems, and/or methods of the present disclosure. 238 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In certain embodiments, the components of the system 900 may be made as small as possible to minimize the amount of soft tissue that is opened in the patient for the osteotomy procedure. Alternatively, or in addition, walls and/or sides of the components may be beveled and/or angled to avoid contact with other hard tissue or soft tissues in the operating field for the osteotomy procedure. 239 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Those of skill in the art will appreciate that for certain osteotomy procedure a complementary component 930 may not be needed or a given complementary component 930 may be optional for use in the osteotomy procedure. Similarly, those of skill in the art will appreciate that certain features of the fasteners 910, resection guides 920, and/or complementary components 930 can be combined into one or more of apparatus or devices or may be provided using a plurality of separate devices. 240 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIG. 10A is a side perspective view of an osteotomy system 1000 according to one embodiment. The osteotomy system 1000 includes a pivoting resection guide 1002 (which may be also referred to as a swiveling resection guide, rotating resection guide, or pivoting burr guide) according to one embodiment, shown secured to a bone. The pivoting resection guide 1002 may also be referred to as a pivoting cut jig, swiveling resection guide, rotating resection guide, bone dissection guide, arc resection guide, or a pivoting cutting guide based on how the pivoting resection guide 1002 operates. In this example, the pivoting resection guide 1002 is secured to a metatarsal bone. Of course, the pivoting resection guide 1002 can be secured to other bones of a patient to guide a surgeon in making cuts in one or more bones. 241 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In certain embodiments, the pivoting resection guide 1002 is used for dissecting one or more bones. For example, in a bunion surgical procedure a surgeon can use a pivoting resection guide 1002 to resect or dissect a distal end of a cuneiform (e.g., medial cuneiform 202). Alternatively, or in addition, the surgeon may use the same pivoting resection guide 1002, or a different pivoting resection guide 1002, to resect or dissect a proximal end of a metatarsal 208 (e.g., first metatarsal 208). Thus, embodiments of the present disclosure can be used for surgical procedures on a single bone, on multiple bones, and at or across the a joint of a patient. 242 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 When secured as illustrated in FIG. 10A, a user may operate the pivoting resection guide 1002 by inserting a cutting tool such as a burr, a burr drill bit, or a drill bit attached to a manual, mechanical, pneumatic, or electric driver into a hole in the guide 1002. A cutting tool may be referred to interchangeably herein as a drill bit. Next, the user may cut into the bone. In the case of a drill bit with longitudinal flutes or burr, the use may initially direct the cutting tool directly into the bone, drilling a hole in the bone. Alternatively, or in addition, the user may initiate an osteotomy of the bone by contacting a rotating cutting section of the cutting tool with a cortex of a bone. Next, a user can pivot the pivoting resection guide 1002 such that the cutting tool (specifically a distal end of the cutting tool) moves laterally in relation to the bone. 243 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 For example, in FIG. 10A, a user may pivot the pivoting resection guide 1002 and direct the cutting tool dorsally, as the cutter guide pivots, the cutting tool cuts bone in the dorsal direction. To move the cutting tool in the dorsal direction, the user moves a proximal end of the cutting tool plantarly. Similarly, the user can pivot the cutter guide such that the cutting tool moves plantarly in relation to the bone, as the cutter guide pivots, the cutting tool cuts bone in the plantar direction. To move the cutting tool in the plantar direction, the user moves a proximal end of the cutting tool dorsally. In this manner, a user can resection or dissect a bone. 244 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 A cutter guide is a guide of the pivoting resection guide 1002 that guides a cutting tool. Advantageously, such resections can be done using very small incisions, incisions just large enough to insert the cutting tool. Alternatively, or in addition, such resections can be done using incisions just large enough to insert the pivoting resection guide 1002 and engage the pivoting resection guide 1002 to the bone. In certain embodiments, the bone resection can be done subcutaneously. In other embodiments, bone resection can be done percutaneously through an incision (e.g., stab incision) made by, or made for, the cutting tool while the pivoting resection guide 1002 presses against a surface of the skin at the incision location. Accordingly, the pivoting resection guide 1002 provides a minimally invasive surgical (MIS) instrument for use in osteotomies. 245 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIG. 10B is a perspective view of a cutting guide, such as pivoting resection guide 1002, according to one embodiment, that includes a handle 1004. The handle 1004 is configured to engage a cutter guide and may serve to facilitate pivoting or swiveling the pivoting resection guide 1002 while resecting or dissecting. A surgeon may move the handle 1004 to direct the resection. Rotary cutting tools such as a drill bit, a mill bit, a router bit, a side-cutting burr, burrs, drill bits, and the like provide a high degree of flexibility in how they are oriented and used to resect or dissect bone. Rotary cutting tools rotate about a longitudinal axis of the cutting tool itself. The pivoting resection guide 1002 guides the rotating cutting tool for a dissection and/or resection. Advantageously, the pivoting resection guide 1002 constrains movement of the rotary cutting tool to motion within a single plane. In particular, where the surgeon has planned to form an osteotomy, such as a resection or dissection, having a particular trajectory and/or position on the bone, the pivoting resection guide 1002 assists the surgeon in making a very precision and accurate resection/dissection within a predetermined plane. 246 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIG. 11A is a top perspective view of an osteotomy system 1000 that includes a pivoting resection guide 1002, a handle 1004 (See FIG. 10B), a first bone attachment feature 1006, a second bone attachment feature 1008, a cutter guide 1010, and one or more fasteners 1012. In one embodiment, the fasteners 1012 are temporary fasteners and can be K-wires, pins, or the like. In one embodiment, the fasteners 1012 are configured to engage one or more bones of a patient’s foot. 247 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 The pivoting resection guide 1002 leverages the first bone attachment feature 1006 and second bone attachment feature 1008 on opposite sides of the cutter guide 1010 to provide a stable platform or base for pivoting the cutter guide 1010 during the osteotomy. The first bone attachment feature 1006 and second bone attachment feature 1008 on opposite sides of the cutter guide 1010 permit the cutter guide 1010 to pivot, swivel, or rotate about a pivot axis in one plane and restrict and prevent movement of the cutter guide 1010 in another plane. In certain embodiments, the pivot axis of rotation for the cutter guide 1010 is an axis that is transverse to a long axis of a cutting tool used with the pivoting resection guide 1002. 248 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In the illustrated embodiment, the first bone attachment feature 1006 and/or second bone attachment features 1008 each include at least one hole configured to receive a pin, such as a fastener 1012. The first bone attachment feature 1006 and/or second bone attachment feature 1008 are configured to secure or anchor the pivoting resection guide 1002 to one or more bones of a patient. The first bone attachment feature 1006 and second bone attachment feature 1008 also serve to hold the cutter guide 1010 in position so accurate cuts can be made using the cutting tool. Consequently, the first bone attachment feature 1006 and second bone attachment feature 1008 are configured to remain in position and hold the cutter guide 1010 despite forces applied to the cutter guide 1010, first bone attachment feature 1006, and second bone attachment feature 1008 by the pivoting action of the cutter guide 1010. 249 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Accordingly, in certain embodiments, the holes of the first bone attachment feature 1006 and second bone attachment feature 1008 and the cross-section diameter of the fasteners 1012 used with the first bone attachment feature 1006 and second bone attachment feature 1008 are sized to withstand these forces. For example, in one embodiment, the holes may be sized to accommodate fasteners 1012 having cross-section diameters of between about 0.8 millimeters to about 2.0 millimeters. Furthermore, the diameter of the holes of the first bone attachment feature 1006 and second bone attachment feature 1008 may be just larger than the diameters of the fasteners 1012 such that the two fit together in a “close fit.” Those of skill in the art will appreciate that the diameters of the holes in the first bone attachment feature 1006 and second bone attachment feature 1008 and the fasteners 1012 can very depending on the diameter of the bone or bones that the fasteners 1012 are deployed into. Smaller diameter bones will use smaller diameter fasteners 1012 and larger diameter bones will use larger diameter fasteners 1012. 250 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 The cutter guide 1010 serves to guide a cutting tool as the cutting tool forms the osteotomy. In particular, the cutter guide 1010 is configured to guide a cutting tool in cutting bone along a predefined plane positioned between the first bone attachment feature 1006 and the second bone attachment feature 1008. The cutter guide 1010 guides the cutting tool as the cutter guide 1010 rotates about a pivot axis 1014. In certain embodiments, the pivot axis 1014 is an axis that is transverse to a longitudinal axis of the fasteners 1012 used to secure the first bone attachment feature 1006 and second bone attachment feature 1008. In one embodiment, the pivot axis 1014 is coupled to the first bone attachment feature 1006 and the second bone attachment feature 1008. The pivot axis 1014 is the axis about which the cutter guide 1010 pivots or rotates as the cutter guide 1010 guides the cutting tool to cut within a predetermined plane. 251 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 The cutter guide 1010 includes an opening that enables the cutter guide 1010 to accept a cutting tool and guide the cutting tool along a predetermined trajectory as the cutter guide 1010 swivels or pivots about the pivot axis 1014 (e.g., an axis transverse to a long axis of the cutter guide 1010). 252 Added by DJM Jan 2024 1/3/24, 4:26 AM

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