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Delete 		PER-23 FIG. 11 illustrates a stage of performing a surgical procedure using a wedge osteotomy system, such as exemplary system 700, or system 800. FIG. 11 illustrates a medial perspective view of a foot and ankle including a medial cuneiform 202, a first metatarsal 208, a second metatarsal 210, a talus 222, a calcaneus 224, a tibia 226, and a navicular 218. FIG. 11 illustrates one example of a resection guide 720 coupled to the bones using bone attachment features 724 that include a first fastener 710a and second fastener 710b, e.g., K-wires. The fasteners 710a,b each engage a midfoot bone of a patient’s foot. In one embodiment, the fasteners 710a,b each engage the same midfoot bone or bones (e.g., fastener 710a may extend through first metatarsal 208 and into second metatarsal 210). Alternatively, or in addition, the fasteners 710a,b each engage a different midfoot bone or bones. 343 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In one embodiment, the user instructions 604 may designate a particular material and/or mass for fabricating one or more guides to be included in the patient-specific osteotomy system 606. Some surgeons may find that patient-specific instruments, such as a patient-specific resection guide may more readily register to one or more bone surfaces if the instrument has a greater mass and/or weight. With the greater mass and a sufficient fidelity bone engagement surface, a patient-specific instrument may seem to find its own way or seek out a desired position on a bone that matches or substantially matches a position planned when the patient-specific osteotomy system 606 was developed. Consequently, a surgeon may request in the user instructions 604 that the instrument be made from a metal such as titanium. 217 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 With the bone model 404 and user instructions 604 a user such as a technician may operate the design module 650 alone or together with other modules of the apparatus 602 to develop a patient-specific osteotomy system 606. In certain embodiments, a single user operates the apparatus 602. Alternatively, or in addition, a plurality of users, which may include an end user, such as surgeon can operate or interact with one or more modules of the apparatus 602 as the patient-specific osteotomy system 606 is designed or developed. 218 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In one embodiment, a technician may provide a patient-specific osteotomy system 606 that includes one or more complementary components and one or more resection guides, which may be patient-specific. The technician may also provide a preoperative plan. These may be provided to an end user (e.g., surgeon) either directly or by accessing the apparatus 602 remotely. The end user may review the preoperative plan and/or the components of the patient-specific osteotomy system 606 (e.g., resection guides) and may approve of the patient-specific osteotomy system 606 or may request changes. In certain embodiments, these changes may include the addition of one or more added bone engagement features, one or more resection guides, a change in a trajectory for a bone attachment feature, a change in trajectory for an osteotomy, an addition of openings in a guide to coincide with openings needed for a fixation system, as well as a plurality of other possible changes to the patient-specific osteotomy system 606. The technician may then make the requested changes and present a revised patient-specific osteotomy system 606 for the surgeon to review again. Next, the surgeon may approve of the revised patient-specific osteotomy system 606 and/or request additional changes. 219 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In the illustrated embodiment, the design module 650 may include a plurality of resection features 652 and/or a plurality of bone engagement features 654. A technician may select one or more resection features 652 and/or one or more bone engagement features 654 and include them in the patient-specific osteotomy system 606. Alternatively, or in addition, a surgeon may designate which resection features 652 and/or bone engagement features 654 to include in the patient-specific osteotomy system 606. 220 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In certain embodiments, the surgeon and technician may collaborate and/or consult with each other regarding the design and/or configuration of the patient-specific osteotomy system 606 and its components. The technician may share with the surgeon information about the technological features and/or limitations of the components of the patient-specific osteotomy system 606 and use the technician’s experience and know-how to make recommendations to the surgeon. The surgeon can present ideas and/or requests regarding what the surgeon would like for components of the patient-specific osteotomy system 606 and the technician can determine whether those ideas/requests can be satisfied using a patient-specific osteotomy system 606. 221 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The apparatus 602 uses both the bone model 404 and user instructions 604 to provide a patient-specific osteotomy system 606. Advantageously, the apparatus 602 enables a surgeon to be involved in the design and development of a patient-specific osteotomy system 606 that is suited not just for the patient, but also for the needs, skills and/or preferences of the surgeon. In this manner, a patient-specific osteotomy system 606 can be provided that improves patient care and accomplishing of desired outcomes. 222 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In one embodiment, the operation of the design module 650 may be completely automated, partially automated, or completely manual. A user may control how automated or manual the designing of the patient-specific osteotomy system 606 is, including patient-specific instrument models, patient-specific instruments, and/or other components of the patient-specific osteotomy system 606. 223 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The apparatus 602 may include a selection module 660 and an export / fabrication module 670. The selection module 660 facilitates the selection and/or customization of one or more complementary components for a patient-specific osteotomy system 606. Complementary components are described herein, but can include certain guides or other aids to facilitate completing a surgical procedure as planned. In one embodiment, the operation of the selection module 660 may be completely automated, partially automated, or completely manual. A user may control how automated or manual the selection module 660 is. 224 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The export / fabrication module 670 is configured to enable exporting of a patient-specific osteotomy system 606 for a variety of purposes including, but not limited to, fabrication/manufacture of one or more patient-specific instruments and/or fixator(s), ordering or fabricating one or more members of the patient-specific osteotomy system 606, generation of a preoperative plan, generation of a physical bone model matching the bone model 404, and the like. 225 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In one embodiment, the export / fabrication module 670 is configured to export the bone model 404, anatomic data 412, one or more patient-specific instrument models 462, a preoperative plan 506, a fixator model 508, or the like. In this manner the custom instrumentation and/or procedural steps for a procedure can be used in other tools. The preoperative plan 506 may include a set of step-by-step instructions or recommendations for a surgeon or other staff in performing a procedure (e.g., a graft harvesting procedure, minimally invasive surgical (MIS) procedure, or the like). The preoperative plan 506 may include images and text instructions and may include identification of instrumentation to be used for different steps of the procedure (e.g., a graft harvesting procedure, minimally invasive surgical (MIS) procedure, or the like). The instrumentation may include a patient-specific instrument, bone engagement features, and/or one or more fixators/fasteners. 226 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 FIG. 7 illustrates an exemplary system 700 for remediating a condition present in a patient’s foot, according to one embodiment. The system 700 can include one or more fasteners 710, one or more resection guides 720, and one or more complementary components 730. While a system 700 can be used for a variety of procedures on one or more body parts, one or more features, components, and/or aspects of the system 700 may be particularly suited for one or more osteotomies on one or more bones of a structure such as a patient’s foot, ankle, wrist, hand, shoulder, or the like. 227 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In certain embodiments, the one or more fasteners 710 can include one or more permanent fasteners and/or one or more temporary fasteners. Typically, the fasteners 710 may be used during a variety of different steps of a procedure. Temporary fasteners are often used because they can securely hold bone or parts/fragments of bones while steps of the procedure are conducted. A common temporary fastener that can be used with system 700 is a K-wire, also referred to as a pin, guide pin, and/or anchor pin. Permanent fasteners 710 (also referred to as implants) such as bone screws, bone staples, sutures, tethers or the like are other examples of fasteners 710 that can be used in a surgical procedure. 228 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The one or more resection guides 720 assist a surgeon in performing different resection or dissection steps for an osteotomy or other procedure. In certain embodiments, a resection guide 720 includes one or more resection features 722 and one or more bone attachment features 724. The resection features 722 can take a variety of forms and/or embodiments. In one embodiment, the resection features 722 take the form of a cut channel or slot or other opening. Alternatively, or in addition, resection features 722 can be of a variety of geometric shapes including: ovals, squares, circles, rectangles, triangles, prisms, and the like. 229 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The resection features 722 provide a guide for a surgeon using a cutting tool to resect a bone, one or more bones, or other tissues of a patient. The resection feature 722 exposes a bone, one or more bones, one or more joints, and/or other hard or soft tissue to the cutting tool while keeping the cutting tool in a predefined area and/or angle and/or trajectory during the resection of the tissue. In certain embodiments, the resection features 722 may guide a surgeon in performing a resection, an osteotomy, and/or a dissection. 230 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The bone attachment features 724 can take a variety of forms and/or embodiments. The bone attachment features 724 may serve to secure the resection guide 720 and/or other instrumentation to one or more bones and/or one or more other structures. For example, the bone attachment features 724 may secure the resection guide 720 during formation of one or more osteotomies. Often, a bone attachment feature 724 can take the form of a hole in and/or through the resection guide 720 that includes a temporary fastener such as a K-wire, pin, or guide pin to secure at least part of the resection guide 720. 231 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 The bone attachment features 724 facilitate attachment (at least temporarily) of a resection guide 720 to one or more bones, or bone fragments, of a patient. The bone attachment features 724 may include any of a wide variety of fasteners or structures including, but not limited to, holes, spikes, prongs, screws, fastening devices, and/or the like. Effective connection of the resection guide 720 to one or more bones across one or more joints and/or to one or more bones can ensure that cut surfaces are formed in desired locations and orientations and mitigate removal of hard tissue and/or soft tissue in undesired locations and/or orientations. 232 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In certain embodiments, a resection guide 720 may include one or more bone engagement surfaces 726 and/or one or more landmark registration features 728. In certain embodiments, a landmark registration feature 728 may extend from one or more sides or ends of a resection guide 720 and engage with one or more landmarks of a bone or joint or anatomical structure of a patient. Registration of the landmark registration feature 728 to a landmark of a bone, joint, or other anatomical part can serve to confirm and/or ensure that a surgeon has located a desired placement and/or orientation for a resection guide 720. This confirmation can assist a surgeon in positioning a resection guide 720 in a predetermined position. 233 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In certain embodiments, the bone engagement surfaces 726 are patient-specific: contoured to match a surface of: one or more bones and/or bone surfaces the resection guide 720 contacts (or is adjacent to) during the procedure or one or more joints proximal to the resection guide 720 during the procedure. Alternatively, or in addition, the bone engagement surface 726 may not be patient-specific, and may, or may not, contact a bone surface during use of the resection guide 720. In certain embodiments, a bone engagement surface 726 may include sections that are patient-specific and other sections that are not patient-specific. in one embodiment, the nonpatient-specific sections may be configured to avoid interfering with placement and securement of the resection guide 720. 234 Added by DJM Jan 2024 1/6/24, 9:56 PM
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Delete 		PER-23 In one embodiment, a skin contact surface may be used in addition to, or in place of, a bone engagement surface. Those of skill in the art appreciate that one or more sides of any of the members of the system 700 may include one or more bone engagement surfaces 726. Consequently, one or more sides of the fasteners 710, the resection guide(s) 720, the complementary components 730, navigation guides 792, and/or the implants 794 may include one or more bone engagement surfaces 726. 235 Added by DJM Jan 2024 1/6/24, 9:56 PM

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