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As explained above, the resection guide 1220 can be positioned, sized, configured, and oriented and/or trajectories set for the resection guide 1220 preoperatively using bone models. Additionally, a surgeon can provide a prescription for the location of guide features (e.g., resection features 722) to account for other conditions of a particular patient. |
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Those of skill in the art will appreciate that the resection guide 1220 can be used for a variety of procedures in a hindfoot, midfoot, forefoot, hand, wrist, elbow, shoulder, and/or the like. One skilled in the art can appreciate that the presented embodiments may be modified, revised, or repositioned to address a surgeon’s particular angles, approach, entry locations and/or preferences. |
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FIG. 15 illustrates one example of an exemplary system 1500 that includes at least a plurality of resection guides 820 for use in a single or a series of surgical procedures. Alternatively, or in addition, the exemplary system 800 may include a plurality of fasteners 810, resection guides 820, and/or complementary components 830. |
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In the illustrated embodiment, a surgeon may plan to resect a wedge segment from each of a tarsometatarsal joint 1502 (“TMT” or Lisfranc joint), a cuneonavicular joint 1504, and a talocancaneonavicular joint 1506 in order to accomplish a desired correction. FIG. 15 illustrates a medial perspective view of bones of a foot. The medial cuneiform 202, first metatarsal 208, navicular 218, talus 222, calcaneus 224, and tibia 226 are illustrated. |
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In the illustrated embodiment, three resection guides 820 (first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c) may be used for form resection cuts to form wedge segments for three separate closing wedge osteotomies. These wedge segments may extend part way into the foot, or through from one side of the foot to the other. |
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Advantageously, the apparatuses, systems, and methods of the present disclosure can be used to plan these osteotomies, determine the desired angles (in one, two, or three planes) for cuts for each wedge segment, a desired depth for the cuts, define suitable resection guides for the surgical procedure, manufacture suitable resection guides for the surgical procedure, and demonstrate how the anatomy will look or reduce once the osteotomies are completed, the bones are positioned, and the surgical procedure is completed. |
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In the illustrated embodiment, a first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c may be designed, developed, and/or fabricated for the procedure. Or course, each of the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c may have one or more resection features and each of the one or more resection features 722 may have a different angle relative to one or more references planes of the foot and/or in relation to each other. In the illustrated embodiment, the angles of the resection features for each of the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c may be defined to correspond to the angles desired for the correction. |
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In the illustrated embodiment, each of the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c can be positioned on the bones as illustrated. Advantageously, each of the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c may include a bone engagement surface 726 that facilitates locating and positioning the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c at each desired location. Furthermore, one or more fasteners 710 may secure the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c to the bones. |
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The first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c may be secured using one or more bone attachment features 724. In certain embodiments, one or more bone attachment features 724 for a single resection guide may cooperate with bone attachment features 724 of an adjacent bone attachment feature 724. For example, once a distal bone attachment feature 724 of distal resection guide 720 (e.g., first resection guide 1520a) is secured using a fastener 710, a fastener 710 deployed in an opening of a proximal bone attachment feature 724 of the distal resection guide 720 (e.g., first resection guide 1520a) can also pass through an opening of a distal bone attachment feature 724 of an intermedial resection guide 720 (e.g., second resection guide 1520b). In this manner, a single fasteners 710 can secure two ends of two different resection guides 720. This same pattern can be used to secure the intermedial resection guide 720 (e.g., second resection guide 1520b) to a proximal resection guide 720 (e.g., third resection guide 1520c). |
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Of course, at the discretion of the surgeon each of the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c may be placed and secured in one stage of the procedure. Or, each of the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c may be positioned and secured in sequence. Furthermore, resections may be performed using one or more of the first resection guide 1520a, second resection guide 1520b, and third resection guide 1520c in series and/or in sequence, again at the discretion of the surgeon. |
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By using two or more wedge segments, a surgeon may combine the effect of the two or more wedge segments to create a single correction angle that is in a single plane, in two planes, in three planes, or the like. Accordingly, the exemplary system 1500 may include multiple resection guides 1520, fasteners 710, and/or complementary components 730. |
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Additionally, a surgeon may use one or more components in an exemplary system to make multiple cuts and/or adjustments 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 can be identified, defined, and reviewed using the apparatuses, systems, and/or methods of the present disclosure. |
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FIG. 16 illustrates an exemplary system 1600, according to one embodiment. The system 1600 illustrates an example of a single resection guide 1620 having a plurality of resection features. |
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The resection guide 1620 may have many structures, features, and functions, operations, and/or configuration similar or identical to those of the resection guides 720 described in relation to FIGS. 7-15, like parts are identified with the same reference numerals. Accordingly, the resection guide 1620 may include a plurality of resection features, bone attachment features, bone engagement surfaces, landmark registration features, and the like. The resection guide 1620 may include a body 732, two connectors 733, anterior side 734, posterior side 736, plantar side 738, dorsal side 742, medial side 744 (facing away from the bones), and/or lateral side 746 (facing the bones). |
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In one embodiment, the resection guide 1620 includes a bone engagement surface (between the resection guide 1620 and the bones) that spans the lateral side 746 of the body 732. The bone engagement surface includes at least one patient-specific surface that can include a contour that mirrors a contour of at least one bone (e.g., medial cuneiform 202, navicular 218, and/or talus 222) of a midfoot. The patient-specific surface is defined at least in part using a bone model 404 of at least one bone (e.g., a midfoot bone) of the patient’s foot. |
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In addition, the resection guide 1620 includes a first resection feature 1622 that extends from the medial side 744 to the lateral side 746. The first resection feature 1622 is configured to guide a cutting tool to form a first osteotomy in at least one midfoot bone (e.g., a talus 222). The first trajectory 1630 defined, at least in part, by the first resection feature 1622 for the first osteotomy is determined based on the bone model 404 of a plurality of midfoot bones. The bone model 404 is based on medical imaging of the patient’s foot. The bone model 404 is configured to significantly resemble the anatomy of the patient's foot. |
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The resection guide 1620 includes a second resection feature 1624 that extends from the medial side 744 to the lateral side 746. The second resection feature 1624 is configured to guide a cutting tool to form a second osteotomy in at least one midfoot bone (e.g., a navicular 218). The second trajectory 1632 defined, at least in part, by the second resection feature 1624 for the second osteotomy is determined based on the bone model 404. |
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The resection guide 1620 includes a third resection feature 1626 that extends from the medial side 744 to the lateral side 746. The third resection feature 1626 is configured to guide a cutting tool to form a third osteotomy in at least one midfoot bone (e.g., a navicular 218). The third trajectory 1634 defined, at least in part, by the third resection feature 1626 for the third osteotomy is determined based on the bone model 404. |
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The resection guide 1620 includes a fourth resection feature 1628 that extends from the medial side 744 to the lateral side 746. The fourth resection feature 1628 is configured to guide a cutting tool to form a fourth osteotomy in at least one midfoot bone (e.g., a medial cuneiform 202). The fourth trajectory 1636 defined, at least in part, by the fourth resection feature 1628 for the fourth osteotomy is determined based on the bone model 404. |
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Depending on the surgical procedure, the needs of the patient, and/or the condition of the bones and other tissues, for certain corrections and/or conditions, the surgeon may resect from the medial side of the foot to the lateral side of the midfoot. Advantageously, the first trajectory 1630 cooperates with the second trajectory 1632 to form a first bone wedge 1638. The third trajectory 1634 cooperates with the fourth trajectory 1636 to form a second bone wedge 1640. Since the osteotomies may extend through a plurality of bones, the first bone wedge 1638 and/or second bone wedge 1640 can includes a plurality of bone fragments. |
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