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Delete 		PER-23 Advantageously, the proximal resection feature 758 and/or distal resection feature 762 can be defined based on, in connection with, and/or may be defined at least partially based on a bone model 404 of one or more bones of a midfoot of a patient. The bone model 404 provides a detailed and accurate representation of the midfoot bones of the patient. Using the apparatuses, systems, and/or methods of the present disclosure the resection guide 720a and/or its components such as the proximal resection feature 758 and distal resection feature 762 can be configured for a specific patient, for a specific surgical procedure, and/or according to specific user instructions and/or preferences of a user (e.g., surgeon). 263 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In one embodiment, the first trajectory 902 is wholly or at least partially determined based on a bone model 404 of the patient’s foot. In particular, the bone model 404 may be of one or more bones, joints, and/or tissues of a midfoot of the patient. The bone model 404 is defined based on medical imaging of the patient’s foot such that the bone model 404 and surfaces and structures of the bone model 404 are highly accurate representations of the actual midfoot bones of a particular patient. The accuracy of the bone model 404 is such that any protuberance, eminence, bony topography, anatomical features, calcifications, void, divot, concave section, sesamoid, bone spur or other feature on, or extending from, a bone of a patient are represented in the bone model 404 (including on surfaces of model bones of the bone model 404). 264 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Alternatively, or in addition, the second trajectory 904 can be wholly or at least partially determined based on one or both of the bone model 404 and the first trajectory 902. For example, in one embodiment, the bone model 404 is used to determine, at least in part, the second trajectory 904. Alternatively, the second trajectory 904 can be defined to be a certain offset, orientation, and/or angle in relation to the first trajectory 902. 265 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In certain embodiments, the proximal resection feature 758 may extend from near the dorsal side 742 to near the plantar side 738. In other embodiments, one of, or both of, the proximal resection feature 758 and the distal resection feature 762 may extend from one of the dorsal side 742 or the plantar side 738 of the body 732. In certain embodiments, the proximal resection feature 758 and distal resection feature 762 intersect each other. In other embodiments, the proximal resection feature 758 and distal resection feature 762 do not intersect. 266 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Thus, upon desired positioning of the resection guide 720 for use, the proximal resection feature 758 may be positioned over at least a portion of a first medial cuneiform or other midfoot bone (e.g., navicular 218), particularly where the resection guide 720 is a medial resection guide, while the distal resection feature 762 may be positioned over, for example, a portion of the first metatarsal 208. In one embodiment, the proximal resection feature 758 is positioned near the distal end of the first cuneiform and the distal resection feature 762 is positioned near the proximal end of the first metatarsal. The proximal resection feature 758 and distal resection feature 762 together, with the bone engagement surface 726 overlying the first cuneiform and the first metatarsal, are positioned to guide resection of one or more midfoot bones during a surgical osteotomy for correcting a condition. 267 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In alternative embodiments, a resection feature may be designed to guide a different type of cutter, such as a drill, mill, or side-cutting burr. In such embodiments, the resection feature may not be a slot, but may instead be a translatable or rotatable cutter retainer that guides translation and/or rotation of the cutter relative to the bone. In certain embodiments, two or more resection features may be replaced by a single resection feature sized to permit a surgeon to resect multiple midfoot bones using a resection guide 720. 268 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In one embodiment, a proximal resection feature 758 is configured to define a first cut surface that can be formed by resecting a first bone. A distal resection feature 762 is configured to define a second cut surface that can be formed by resecting a second bone. In such an embodiment, one or the other or both of the first cut surface and the second cut surface can be oriented according to one or more angles relative to landmarks on the bones or other anatomical structures. 269 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Alternatively, or in addition, in certain embodiments, one or both of, the proximal resection feature 758 and distal resection feature 762 may be positioned on, or in, the body 732 and/or have an orientation based on patient imaging data. The patient imaging data can be used to position and orient one, or both, of the proximal resection feature 758 and distal resection feature 762 such that formation of one, or both, of the first cut surface and the second cut surface and fixation of the two cut surfaces against each other mitigates a condition of the patient. For example, as described in the present disclosure, patient imaging data can be used to generate bone models of bones of the patient. The bone models can be used to determine and/or define contours for a bone engagement surface 726, a position for a proximal resection feature 758, an orientation for a proximal resection feature 758, a position for a distal resection feature 762, an orientation for a distal resection feature 762, as well as other features and attributes of one or more patient specific instruments that can be used in a procedure. 270 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The resection guide 720 includes one or more bone attachment features 724. The bone attachment features 724 are configured to engage one or more bones of the patient to couple the body 732 to one or more bones of the patient. As embodied in FIGs. 9A through 9G, the bone attachment features 724 may take the form of one or more holes 764 that extend from the medial side 744 to the lateral side 746 and/or one or more fixation devices (e.g., fasteners 710). The holes 764 may be shaped to accommodate pins, K-wires, and/or other elongated bone fixation elements that can be anchored in a first cuneiform and/or a first metatarsal to keep the resection guide 720 in place. 271 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In the illustrated embodiment, the posterior side 736 includes a first bone attachment feature 766 and the anterior side 734 includes a second bone attachment feature 768. In one embodiment, the holes 764 of the first bone attachment feature 766 are aligned with the second bone attachment feature 768. Alternatively, or in addition, the first bone attachment feature 766 and second bone attachment feature 768 are not aligned with each other. 272 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 When a surgeon prepares to do an osteotomy, they take care to prepare for the surgical procedure by gathering as much information as possible about the patient’s anatomy, the surgical procedure, the instrumentation that will be used, and any implants to be used such that the goals of the surgical procedure can be realized. This preparation helps because once an osteotomy is performed changing or remediating the impact of the osteotomy can be challenging and can take time for bones to heal and recover. Thus, a surgeon seeks to perform osteotomies that are only in the desired locations, with the desired trajectories, and to a desired depth. The goal of the osteotomies is to provide a correction and/or relief for a patient. 273 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 To facilitate a successful surgical procedure, surgeons appreciate any guidance and advanced indications of signs as to where an osteotomy will be made and/or how the osteotomy will extend into the tissue of the patient and how a reduction after the osteotomy will do in providing for the desired outcome. One sign or indicator that surgeons appreciate is a trajectory marker that is in one or more bones of the patient and indicates the trajectory the osteotomy will take. Advantageously, the present disclosure can provide such indicators by way of the bone attachment features 724. 274 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In one embodiment, the bone attachment features 724 are configured to enable fasteners 710 used with the bone attachment features 724 to extend into one or more bones of the patient. Specifically, the fasteners 710 can be deployed into the bone attachment features 724 and will thereby show a surgeon what the trajectory will be for an osteotomy formed using the resection features 722. In certain embodiments, this can be accomplished because a hole 764 for a bone attachment feature 724 may extend through the body 732 to guide the fasteners 710 along a trajectory that is parallel to the trajectory of the resection feature 722 (e.g., first trajectory 902 and/or second trajectory 904) for the osteotomy that the cutting tool will cut. Of course, this parallel relationship can be implemented in one or more of the bone attachment features 724 of the resection guide 720a. 275 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Advantageously, a surgeon can leverage this feature prior to making any cuts, forming any osteotomies. For example, a surgeon can secure the resection guide 720a to one or more bones of the patient on a medial side of the midfoot. The fasteners 710 cooperating with the bone attachment features 724 can extend into the middle, and/or through to the lateral side of the midfoot. Since the fasteners 710 are often made of metal, the surgeon can then use fluoroscopy to visually see and/or check the trajectory for each fastener 710 into the midfoot. The surgeon knows that an adjacent and parallel osteotomy formed using the resection features 722 will track with the trajectories of the fasteners 710 in the bone attachment features 724. In this manner, a surgeon can confirm trajectories for the planned osteotomies before the actually making the osteotomies. If the surgeon is not satisfied with the trajectories indicated by the bone attachment features 724 by way of the deployed fasteners 710 a surgeon can make an adjustment and removing the fasteners 710 has minimal impact on the patient and/or the success of the procedure. 276 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The body 732 connects the proximal resection feature 758 to the distal resection feature 762. Alternatively, or in addition, the body 732 connects to the bone attachment features 724. In one embodiment, the resection guide 720 may include a connector 733 or coupler 733. The connector 733 may be a part of the body 732 or a separate component. The connector 733 is between the proximal resection feature 758 to the distal resection feature 762. 277 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In certain embodiments, a user may provide user instructions regarding the size and/or configuration of the body 732 and/or the connector 733. For example, the user may wish to make the body 732 as small and narrow as possible. A larger resection guide 720 may require larger incisions which could lead to longer recovery times for a patient. However, the smaller the body 732, the less surface area of a patient-specific bone engagement feature, such as a bone engagement surface on a bone facing side of the resection guide 720. The smaller patient-specific bone engagement feature may make positioning the resection guide 720 in a predetermined position more challenging. Thus, the user (e.g., surgeon) may weigh the benefits and challenges in the trade-off between the size of the body 732 and/or connector 733 and corresponding size of a patient-specific bone engagement feature versus the ease of positioning the resection guide 720 during the surgical procedure. 278 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 As described in the present disclosure, a resection guide 720a can be specifically designed for a particular patient. The resection guide 720 is patient-specific. The resection guide 720 facilitates making one or more osteotomies through one or more bones of a midfoot of a patient. In addition, the resection guide 720 assists a surgeon in knowing that a position of a resection guide 720 during surgery is the same or substantially the same as a predetermined position defined earlier. In one embodiment, the predetermined position is a position that has been defined and/or confirmed and/or agreed to by the surgeon using the bone model 404 and/or a model of the resection guide 720. In the system 400, for example, a surgeon can use a registration module 440 to register a preliminary model of the resection guide 720 to one or more bones of the bone model 404. Using the apparatus 402, a surgeon can leverage a patient-specific model of one or more bones of a patient and a model of the resection guide 720 to define one or more patient-specific bone engagement features for the resection guide 720. In this manner, the predetermined position includes a position on one or more bones of a patient. The predetermined position may be defined preoperatively using a model of a resection guide and a bone model. 279 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In one embodiment, the resection guide 720 (e.g., resection guide 720a) includes at least one patient-specific bone engagement feature. A patient-specific bone engagement feature serves to engage with one or more bones and/or other tissue of a patient to position or identify a position of the resection guide 720 relative to the one or more bones that satisfies and/or matches a predetermined position defined using the models (e.g., bone model 404 and/or preliminary model of the resection guide 720). In certain embodiments, a patient-specific bone engagement feature is one example of a reference feature that can assist a user (e.g., surgeon). 280 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 FIG. 9C illustrates one example of a patient-specific bone engagement feature 906. The patient-specific bone engagement feature 906 is configured to engage at least a portion of one or more bones of a patient during a surgical procedure. The patient-specific bone engagement feature 906 engages the one or more bones and/or joints in a manner that positions the resection guide 720 in a predetermined position. Advantageously, the patient-specific bone engagement feature 906 includes features, structures, and/or aspects that provide feedback to a user moving the resection guide 720 in relation to surfaces of one or more bones of the patient. These features, structures, and/or aspects of the patient-specific bone engagement feature 906 cause the resection guide 720 to shift and tilt as a user moves the resection guide 720 to an approximate position on the bones. However, since the features, structures, and/or aspects are mirror images of the recesses, bumps, projections, and/or surface features of the one or more bones, the resection guide 720 will lock into place once the resection guide 720 is moved to the same (or substantially the same) position on or relative to the one or more bones as the predetermined position. The patient-specific bone engagement feature 906 causes the resection guide 720 to lock and/or snap into place once the correct position that matches the predetermined position is located. 281 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 Those of skill in the art will appreciate that a patient-specific bone engagement feature 906 can take a variety of forms and/or configurations and can include a single structure or a plurality of structures that together form the patient-specific bone engagement feature 906. The patient-specific bone engagement feature 906 can be a single surface (e.g., a bone engagement surface) that is contoured, a surface in cooperation with a body structure that accounts for rises or falls in a contour of the one or more bones. Alternatively, or in addition, a patient-specific bone engagement feature 906 can include a struct or arm or other structure that extends from the body 732 and supports a contoured bone engagement surface. 282 Added by DJM Jan 2024 1/6/24, 9:56 PM

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