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Delete 		PER-24 A reduction guide 760 can help a surgeon position and/or orient one or more bones, parts of bones, or other parts of a patient as part of a procedure in order to reduce the bone, bones, bone parts, or other parts and/or in order to position and/or orient the bone, bones, bone parts, or other parts to a desired position and/or orientation. In certain embodiments, aspects and/or features of a reduction guide 760 can be integrated into one or more other components of an osteotomy system 700, such as components of the complementary components 730. A compression guide 770 can help a surgeon compress one or more bones, parts of bones, or other parts of a patient together or against an implant as part of a procedure. In certain embodiments, compression guide 770 can be a separate instrument such as a compressor and/or a combined compressor/distractor. The compressor / distractor can be used to compress two or more cut faces formed by an osteotomy until fixation is deployed or distract bones or parts of bones involved in a procedure. In certain embodiments, a compression guide 770 may serve a dual purpose as both a compression guide 770 and as a positioning guide 780. The same instrument may be used to both translate and/or rotate bones or bone fragments and compress two or more cut faces formed by an osteotomy until fixation can be deployed. 226 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 A positioning guide 780 (also referred to as a positioner) can help a surgeon position one or more bones, parts of bones, or other parts of a patient as part of a procedure. For example, a positioning guide 780 may hold one bone or bone fragment stable and hold one or more other bone fragments in a desired position while permanent or temporary fixation is deployed. In certain embodiments, the positioning guide 780 may hold bone fragments in a reduced position, and thus may function as both a positioning guide 780 and/or a reduction guide 760. 227 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In certain embodiments, the positioning guide 780 may be designed and fabricated to be patient-specific. The patient-specific aspects can include a patient-specific bone engagement surface, a predefined angle for reorienting one or more bone or bone parts within one or more planes, a predefined position for bone attachment features 724 or fasteners 710, a predefined or patient-specific offset or amount of translation that is provided, or the like. Alternatively, or in addition, the positioning guide 780 may be selected from a kit, collection, or repository of a number of positioning guides 780: each having a different configuration for one or more aspects/attributes of the positioning guide 780. For example, each member of the repository/kit may include a different positioning angle (repositioning or correction angle), the angles may differ by 2 degrees for example. In such an embodiment, each positioning guide 780 may not be patient-specific to a particular patient but may provide the desired amount of positioning to meet the goals of the surgeon. In certain embodiments, a preoperative plan generated based on the present disclosure may include a recommendation for the positioning guide 780 to be used, even if the recommended positioning guide 780 is not patient-specific to the particular patient. 228 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 A fixation guide 790 can help a surgeon in completing one or more temporary or permanent fixation steps for one or more bones, parts of bones, or other parts of a patient as part of a procedure. The fixation guide 790 may include and/or may use one or more components of a fastener or fixation system including implant hardware of the fastener or fixation system. 229 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Those of skill in the art will appreciate that the other complementary components 730 may each have functions, purposes, and/or advantages with respect to one or more anatomical parts of the patient. Alternatively, or in addition, the other complementary components 730 may each have functions, purposes, and/or advantages with respect to one or more instruments and/or one or more anatomical parts of the patient. For example, a trajectory guide may be a type of alignment guide 740 in that the trajectory guide facilitates alignment of fixation with the desired location and/or trajectory/orientation with respect to one or more anatomical parts of the patient. Alternatively, or in addition, a trajectory guide may also be considered a type of fixation guide 790 because the trajectory guide facilitates deployment of one or more fasteners 710. 230 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Advantageously, the system 700 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 710, resection guide(s) 720, and/or complementary components 730 can be configured to assist in overcoming this challenge. 231 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Advantageously, system 700 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. System 700 can include a number of features, including patient-specific features, to assist the surgeon with the positioning. In one embodiment, the resection guide 720 can include one or more landmark registration features 728. 232 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Advantageously, the system 700 can help a surgeon in securing guides of the osteotomy system 700, 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 700 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, system 700 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, system 700 accommodates translation and/or rotation of the bones during the osteotomy procedure while facilitating a successful outcome for the osteotomy procedure. 233 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Advantageously, the components of the system 700 can be specifically designed for a particular patient. Alternatively, or in addition, the components of the system 700 can be specifically designed for a class of patients. Each of the components of system 700 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 for an optimal osteotomy with minimal risk of undesirable resection. In one embodiment, the components of system 700 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 722 in a resection guide 720 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. 234 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In certain embodiments, the exemplary system 700 may include a plurality of fasteners 710, resection guides 720, and/or complementary components 730. 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. 235 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Additionally, a surgeon may use one or more components in an exemplary system 700 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 700 can be identified, defined, and reviewed using the apparatuses, systems, and/or methods of the present disclosure. 236 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In certain embodiments, the components of system 700 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. 237 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Those of skill in the art will appreciate that for certain osteotomy procedures a complementary component 730 may not be needed or a given complementary component 730 may be optional for use in the osteotomy procedure. Similarly, those of skill in the art will appreciate that certain features of the fasteners 710, resection guides 720, and/or complementary components 730 can be combined into one or more of apparatus or devices or may be provided using a plurality of separate devices. 238 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIG. 8 illustrates an exemplary ankle fusion osteotomy system 800, according to one embodiment. The osteotomy system 800 can include one or more fasteners 810 and/or two or more sets of fasteners (810a, 810b, 810c, 810d), one or more resection guides 820, and zero or one or more complementary components 730. In the illustrated embodiment, the resection guides 820 include a tibial resection guide 822 and a talus resection guide 824. The resection guides 820 may also include one or more of resection features 826, bone attachment features 828, bone engagement feature 830, and/or landmark registration feature 834. In certain embodiments, a bone engagement feature 830 can include a bone engagement surface 832. 239 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 While specific embodiments of complementary components 730 are not specifically shown here in relation to the osteotomy system 800, those of skill in the art will appreciate that complementary components 730 can be similar in feature, design, implementation, configuration, and purpose as those described in relation to the osteotomy system 700 and can be used for the osteotomy system 800. Thus, the osteotomy system 800 can include one or more alignment guides 740, rotation guides 750, correction guides 760, compression guides 770, positioning guides 780, fixation guides 790, navigation guides 792, implants 794, or the like. 240 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Either or both of the resection guides 820 may be custom patient-specific resection guides made for a particular patient and/or for a particular surgical procedure. Various aspects of the resection guides 820 may be patient-specific, including, but not limited to, an angle and/or orientation for a resection feature of the resection guide 820, a position of the resection feature, a depth of the resection feature, a size of the resection guide 820, a configuration and/or composition of a bone contacting surface such as a bone engagement surface of the resection guide 820, and the like. 241 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In one embodiment, the tibial resection guide 822 includes a body 836 that includes an anterior side 838, a posterior side 840, a medial side 842, a lateral side 844, a superior side 846, and an inferior side 848. The talus resection guide 824 may also include a body 850 that includes an anterior side 852, a posterior side 854, a medial side 856, a lateral side 858, a superior side 860, and an inferior side 862. 242 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In the illustrated embodiment, the tibial resection guide 822 and talus resection guide 824 are separate instruments. Advantageously, using two separate resection guides can enable a surgeon to adapt intraoperatively to an amount of rotation and/or translation of one or more bones the soft tissue around the bones will permit. Specifically, one resection guide (e.g., tibial and/or talus) may include a resection feature with a first angle for correction, a second resection guide may include a resection feature with a second angle for correction greater than the first, a third resection guide may include a resection feature with a third angle for correction greater than the second, and so forth. These different resection guides may be part of a kit available to the surgeon during the surgery. In this manner, a surgeon can choose a resection guide with a preferred angle for correction during the surgery. 243 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In another embodiment, the tibial resection guide 822 and talus resection guide 824 and/or components of the tibial resection guide 822 and talus resection guide 824 may be combined into a single instrument. In another embodiment, the tibial resection guide 822 and/or talus resection guide 824 may include a coupler that enables the tibial resection guide 822 and talus resection guide 824 to be coupled together before or during a surgical procedure. 244 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In certain embodiments, a position of one or more of a resection feature 826 of the tibial resection guide 822 and/or a resection feature 826 of the talus resection guide 824 can be determined and/or defined at least partially based on a bone model of at least a portion of a bone of a patient's foot. In one embodiment, the resection features 826 may be positioned to remove a minimal amount of bone and implement a deformity correction. 245 Added by DJM Jan 2024 1/6/24, 10:01 PM

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