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Delete 		PER-24 Pins of four bone attachment features 828 (e.g., one or more tibial bone attachment features and one or more talus bone attachment features) have also been deployed to secure the first resection guide 2222 to bone. Note that the first resection guide 2222 includes an alignment guide 2274 with a shaft 2278 inserted. A surgeon can now visually check manually, and/or with flouroscopy, a position of the first resection guide 2222 in relation to a mechanical axis 880 of the tibia 226. A surgeon can now form a curved osteotomy in a sagittal plane 262 using the first resection feature 2264 and a cutting tool such as a burr. 440 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In the illustrated embodiment, the surgeon has made an incision that permits access to a lateral surface of a distal end of a tibia and lateral surface of a proximal end of a talus of a patient’s foot. In one embodiment, the surgical procedure may be a revision procedure of a prior ankle fusion. Accordingly, one of the first resection guide 2222 and/or the second resection guide 2224 can form an osteotomy on one or the other of a tibia 226 and a talus 222. 439 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIG. 25A illustrates a stage of an osteotomy surgical procedure in which a first resection guide 2222 is positioned on a medial surface of an ankle joint. The first resection guide 2222 is positioned for an osteotomy of a talus 222 or a tibia 226. However, the osteotomy of the talus 222 may also resect a portion of a distal end of a tibia 226, and vice versa. 438 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIGs. 25A-25E illustrate different views of a surgical osteotomy procedure using the osteotomy system of FIG. 22, according to one embodiment. 437 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIGs. 24A-24G illustrate different views of one example second resection guide 2224. In one embodiment, the second resection guide 2224 includes a body 2402 that includes an anterior side 2404, a posterior side 2406, a medial side 2408, a lateral side 2410, a superior side 2412, and an inferior side 2414. Generally, the sides of the second resection guide 2224 refer to the direction the sides face when the second resection guide 2224 is in use. FIG. 24A is an anterior perspective view of one example second resection guide 2224. FIG. 24B is a medial view of the example second resection guide 2224 of FIG. 24A. FIG. 24C is a lateral view of the example second resection guide 2224 of FIG. 24A. FIG. 24D is an anterior view of the example second resection guide 2224 of FIG. 24A. FIG. 24E is a posterior view of the example second resection guide 2224 of FIG. 24A. FIG. 24F is a superior view of the example second resection guide 2224 of FIG. 24A. FIG. 24G is an inferior view of the example second resection guide 2224 of FIG. 24A. FIGs. 24C, 24D, 24E, and 24G include views of the bone engagement surface 2232. In certain embodiments, the second resection guide 2224 can include one or more landmark registration features 2234. 436 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIGs. 23A-23G illustrate different views of one example first resection guide 2222. In one embodiment, the first resection guide 2222 includes a body 2302 that includes an anterior side 2304, a posterior side 2306, a medial side 2308, a lateral side 2310, a superior side 2312, and an inferior side 2314. Generally, the sides of the first resection guide 2222 refer to the direction the sides face when the first resection guide 2222 is in use. FIG. 23A is an anterior perspective view of one example first resection guide 2222. FIG. 23B is a medial view of the example first resection guide 2222 of FIG. 23A. FIG. 23C is a lateral view of the example first resection guide 2222 of FIG. 23A. FIG. 23D is an anterior view of the example first resection guide 2222 of FIG. 23A. FIG. 23E is a posterior view of the example first resection guide 2222 of FIG. 23A. FIG. 23F is a superior view of the example first resection guide 2222 of FIG. 23A. FIG. 23G is an inferior view of the example first resection guide 2222 of FIG. 23A. FIGs. 23C, 23D, 23E, and 23G include views of the bone engagement surface 2232. In certain embodiments, the first resection guide 2222 can include one or more landmark registration features 2234. 435 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 The resection guide 2222 and/or resection guide 2224 of osteotomy system 2200 can include some, or all of the same or substantially the same features, aspects, and/or components as the resection guides 820 and/or first resection guide 1822 and/or second resection guide 1824 described herein with like components including the same reference numerals. Accordingly, the resection guides 2220 can or may include one or more resection features, one or more bone attachment features, one or more bone engagement features, one or more alignment guides, one or more shafts, one or more openings, one or more resection guards, one or more fastener guides, and/or the like. 434 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 The resection guides 2222 may each include a body that includes an anterior side, a posterior side, a medial side, a lateral side, a superior side, and an inferior side. In certain embodiments, a first resection guide 2222 may be combined with a second resection guide 2224 into a single resection guide 2220. 433 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 2220 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 2220 may be patient-specific, including, but not limited to, an angle and/or orientation for a resection feature of the resection guide 2220, a position of the resection feature, a depth of the resection feature, a size of the resection guide 2220, a configuration and/or composition of a bone contacting surface such as a bone engagement surface of the resection guide 2220, and the like. 431 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In particular, the curved osteotomy is formed by a pattern of a plurality of openings arranged in a curve within the body of the second resection guide 1824. In the illustrated embodiment, the pattern is a downward curve shape. 384 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 The curved osteotomy is determined, at least partially, based on a bone model of at least a portion of the patient's ankle. The bone model is based on medical imaging of the patient's ankle. Those of skill in the art will appreciate that a curved osteotomy and an angled curved osteotomy are formed by a first resection feature 1864 and/or a second resection feature 1866 having a trajectory in relation to the a bone to be resected that matches or substantially matches the angle that the curved osteotomy and/or angled curved osteotomy will have once a cutting tool is used to form the curved osteotomy and/or angled curved osteotomy by way of the first resection feature 1864 and/or a second resection feature 1866. 385 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In the illustrated embodiment, by forming a bone tunnel in the bone aligned with each of the plurality of openings in the second resection feature 1866, and then interconnecting the bone tunnels, a curved shape (like a dome) can be formed on an end or within a bone of a patient. The bone tunnels can be interconnected by angling a burr cutting tool within one opening in one direction and/or the other (e.g., medially and/or laterally). In one embodiment, the openings of the plurality of openings have a diameter that permits a burr cutting tool to be moved in a way to interconnect bone tunnels. Alternatively, or in addition, the bone tunnels can be interconnected by using an osteotome to remove walls between adjacent bone tunnels. 386 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In the illustrated embodiment, a curved osteotomy may refer to an osteotomy formed using from a lateral side or a medial side of an ankle of a patient. (e.g., lateral approach or medial approach). When using this approach a curved osteotomy can be formed in which the osteotomy extends into the bone (e.g., tibia 226 and/or talus 222) at a second angle 1898 (See FIG. 21D) that is perpendicular to a mechanical axis 880 of the bone being resected (e.g., tibia 226 or talus 222). The second angle 1898 may be measured based on a trajectory for how the curved osteotomy extends into the bone within the frontal plane 264. Such a curved osteotomy may be referred to as a straight cut. Alternatively, or in addition, instead of a curved osteotomy, resection guides 1820 may each include resection features for forming angled curved osteotomies. 387 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In one embodiment, the first angle 1896 and the second angle 1898 are determined at least partially based on a bone model of at least a portion of a patient’s ankle. Advantageously, a surgeon can define and/or determine the values for the first angle 1896 and/or second angle 1898. 388 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 For example, a surgeon may provide these values in a set of user instructions 604. Alternatively, or in addition, the surgeon may review an initial version of an osteotomy system 1800, and based on that review may revise the first angle 1896 and/or second angle 1898. In one embodiment, a preoperative plan can show a surgeon either through an animation and/or a series of images and/or a text description a condition of an ankle and bones of a patient before the osteotomies with one version of an osteotomy system 1800 and a position and/or alignment of the bones and/or ankle after completion of osteotomies using the osteotomy system 1800 and reducing the bones. Accordingly, a surgeon can review the planned positioning and outcome and review the first angle 1896 and/or second angle 1898. Based on the surgeon’s professional judgment, the surgeon may decide to revise the first angle 1896 and/or second angle 1898. Alternatively, or in addition, a surgeon may confirm the settings and/or values for the first angle 1896 and/or second angle 1898. For example, after reviewing a preoperative plan with the first angle 1896 and/or second angle 1898 set at a particular set of angles. 389 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In another embodiment, a surgeon may request that two or more resection guides 1820 be fabricated for the osteotomy system 1800 with the intention of using particular resection guides 1820 (i.e., a subset of the two or more resection guides 1820) during the surgical procedure and making the final decision intraoperatively. For example, two or more of the resection guides 1820 may be configured to form angled curved osteotomies using a different first angle 1896. 390 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIGs. 19A-19G illustrate different views of one example first resection guide 1822. In one embodiment, the first resection guide 1822 includes a body 1902 that includes an anterior side 1904, a posterior side 1906, a medial side 1908, a lateral side 1910, a superior side 1912, and an inferior side 1914. Generally, the sides of the first resection guide 1822 refer to the direction the sides face when the first resection guide 1822 is in use. FIG. 19A is an anterior perspective view of one example first resection guide 1822. FIG. 19B is lateral view of the example first resection guide 1822 of FIG. 19A. FIG. 19C is a medial view of the example first resection guide 1822 of FIG. 19A. FIG. 19D is a posterior view of the example first resection guide 1822 of FIG. 19A. FIG. 19E is an anterior view of the example first resection guide 1822 of FIG. 19A. FIG. 19F is a superior view of the example first resection guide 1822 of FIG. 19A. FIG. 19G is an inferior view of the example first resection guide 1822 of FIG. 19A. FIGs. 19C, 19D, 19E, 19F, and 19G include views of the bone engagement surface 1832. In certain embodiments, the first resection guide 1822 can include one or more landmark registration features 1834. 391 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 one objective in using the resection guides 1820 can be to form a curved osteotomy and/or an angled curved osteotomy. There are a number of ways to configure the resection guides 1820 to reach this objective. In one embodiment, a trajectory for resection of bone can be controlled and/or managed by an angle of the first resection feature 1864 and/or second resection feature 1866 through a body of the resection guide 1820. 392 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Alternatively, whereas in the present disclosure, a resection guide 1820 can be fabricated with a bone facing side (e.g., medial side 1908) that is contoured to a shape, size, contour, and configuration of a surface of the bone, those of skill in the art will appreciate that first resection feature 1864 and/or second resection feature 1866 may extend perpendicular through a body of the resection guide 1820. However, a change in the resection trajectory can be accomplished by changing a distance between a non-bone facing side surface (e.g., lateral side 1910) and a bone facing side (e.g., medial side 1908) surface of a body of the resection guide 1820 such that one end of a resection guide 1820 is closer to the bone than the other side when the resection guide 1820 is deployed. Thus, by varying the depth of the body across the bone facing side (e.g., medial side 1908) of the body, a designer can cause the a resection feature to contact the bone at a desired angle (e.g., first angle 1896 and/or second angle 1898). 393 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIGs 19A-19C illustrate that the example first resection guide 1822 includes one or more stabilizers 1892 and one or more sights 1894. In the example first resection guide 1822 the bone attachment features 1828 are configured such that holes/openings in the body 1902 are parallel to each other and therefore the pins deployed into these holes are also parallel to each other. Having parallel pins can be advantageous because the parallel pins can enable the first resection guide 1822 to be readily removed by sliding the body 1902 off of the pins. In this manner, the pins can remain in the bone(s) and can serve as reference features. However, the parallel pins can also result in the body 1902 being unstable and moving too much during the osteotomy. For example, the body 1902 may move away from the bone(s) along the pins (a translation referred to as riding up). 394 Added by DJM Jan 2024 1/6/24, 10:01 PM

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