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Delete 		PER-10 FIG. 24B illustrates a diagram representative of a cross-sectional view of a first metatarsal 230 from a proximal base (represented as a circle) looking towards the distal head. FIG. 24B illustrates the relationship between the bone attachment feature 2410 and the distal alignment feature 1990/2290. Angle C represents the number of degrees between the first positioned and the second position that the bone will be rotated to once rotated about the longitudinal axis 1976/2276. In certain embodiments, angle C may range between about 0 and about 35 degrees. 279 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 Referring now to FIG. 24A, a surgeon may not know per-operatively how much rotation is needed or can be achieved given the condition and anatomy of the patient. Accordingly, the present disclosure may include a number of pin guides 2400 each with a different number of degrees of correction built into the placement of the distal alignment feature 1990/2290 relative to the bone attachment feature 2410. Examples include a 25 degree pin guide 2400, 30 degree pin guide 2400, 35 degree pin guide 2400, 40 degree pin guide 2400, 10 degree pin guide 2400, 15 degree pin guide 2400, and the like. Each pin guide 2400 that provides a different number of degrees of rotation may include a marking that identifies the number of degrees (e.g., “25”, “30”, etc.). Alternatively, or in addition, certain pin guide 2400 may be configured for use on a joint of a left foot versus a right foot. Similarly, such pin guide 2400 may include an indicator of which foot the guide is to be used with (e.g., “Left”, “Right”). Those of skill in the art will appreciate that the degrees for the pin guide 2400 may range from about 2 degrees to about 100 degrees. 280 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 In the illustrated embodiment, the bone attachment feature 2410 is perpendicular to the first slot 1960/2260 and parallel to the distal alignment feature 1990/2290 that can be coupled to the first metatarsal 230. 281 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 In one embodiment, after a surgeon selects that desired amount of offset by choosing a pin guide 2400 with a desired number of degrees, the surgeon positions the selected pin guide 2400 on the first metatarsal 230 by sliding the holes 2412 over the fasteners 1956. Placement of the pin guide 2400 positions the distal alignment feature 1990/2290 for subsequent rotation of the bone. Next, a surgeon may insert two fasteners 1956 into holes of the distal alignment feature 1990/2290. The fasteners 1956 may mark the position for alignment and sit securely in the bone. 282 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 Next a surgeon may de-rotate or rotate the first metatarsal 230 for subsequent fusion to the first cuneiform 210. De-rotation refers to rotation of the first metatarsal 230 about the longitudinal axis 1976/2276 such that the first metatarsal 230 assumes a position before the condition presented, for example a hallux valgus condition. As noted de-rotation may mean rotating the first metatarsal 230 counterclockwise. 283 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 FIG. 24C shows one way de-rotation may be performed. FIG. 24C illustrates a perspective view of the first cuneiform and the first metatarsal of FIG. 24A with a pin guide connected. A surgeon may use various ways, devices, or methods to de-rotate the first metatarsal 230. In one embodiment, the pin guide 2400 may include a coupler, such as a threaded hole 2414 configured to thread onto an end of a handle 2416. A surgeon may connect the handle 2416 to the pin guide 2400 by way of the threaded hole 2414. A surgeon can then use the handle 2416 to guide and rotate or de-rotate the first metatarsal 230 into a desired position. In the illustrated embodiment, the surgeon may de-rotate the first metatarsal 230 until the distal alignment feature 1990/2290 substantially aligns with the proximal alignment feature 1980/2280. Alternatively, or in addition, the surgeon may rotate the first metatarsal 230 using fasteners 1956 of the distal alignment feature 1990/2290 and/or the bone attachment feature 2410. 284 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 FIG. 25A illustrates a perspective view of the first cuneiform and the first metatarsal of FIG. 23 with one embodiment of a de-rotation handle. As an alternative to using a pin guide 2400 a surgeon may connect a de-rotation handle 2500 to fasteners 1956 of the distal bone attachment feature 1954/2254. The de-rotation handle 2500 may be connected to extend laterally such that once the first metatarsal 230 is de-rotated two more fasteners 1956 can be inserted into the first metatarsal 230 at a position that substantially aligns with the proximal alignment feature 1980/2280. 285 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 FIG. 25B illustrates a perspective view of the first cuneiform and the first metatarsal of FIG. 25A with the de-rotation handle and first metatarsal rotated. Once the first metatarsal 230 has been de-rotated a surgeon may connect an alignment handle 2510 to fasteners 1956 of the proximal alignment feature 1980/2280. The alignment handle 2510 may include two proximal alignment holes 2512 and two distal alignment holes 2514. A surgeon may rotate or de-rotate the first metatarsal 230 using the de-rotation handle 2500 until the first metatarsal 230 is in a desired de-rotated/rotated position. Next, a surgeon may slide the proximal alignment holes 2512 over the fasteners 1956 of the proximal alignment feature 1980/2280. The distal alignment holes 2514 may be aligned with the proximal alignment holes 2512. Next, a surgeon may insert a fasteners 1956 (e.g., K-wire) into the distal alignment holes 2514. The fasteners 1956 of the distal alignment holes 2514 may serve as the distal alignment feature 1990/2290. Next, the osteotomy may include a final alignment and compression step. 286 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 Advantageously, the fidelity of the patient imaging data enables the bone model, preliminary cutting guide model, and patient specific instrument (e.g., patient specific cutting guide, patient specific pin guide, patient specific alignment guide, etc.) to uniquely match a particular patient. Consequently, the bone engagement surface 2224 can engage the surfaces of the bones of a joint in a single configuration. Such a close matching fit facilitates the surgical osteotomy. 249 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 FIGS. 21A, 21B illustrate a perspective view of a first cuneiform and a first metatarsal with one embodiment of a patient-specific cutting guide. Prior to resection completed in the illustrated stage of FIG. 20, a surgeon may desire to check or confirm that the desired cutting guide is being used and that a selected cutting guide will provide a desired alignment between the bones of the foot after the resection and fixation steps. 237 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 Accordingly, in the illustrated embodiment, the cutting guide 1900 may include one member of a coupler 2010 configured to engage a corresponding member of the coupler coupled to an alignment guide 2020. Those of skill in the art appreciate that various designs of a coupler may be used. In the illustrated embodiment, the coupler 2010 includes an opening 2012 (See FIG. 20) that may extend from the superior side 1920 into the body 1910 through to the inferior side 1922 and a post 2014. In one embodiment, the opening 2012 may include one of the slots, such as second slot 1970. The post 2014 may include an engagement member 2016. 238 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 In one embodiment, the opening 2012 and the post 2014 engage each other in a friction fit. For example, the post 2014 may slide into the second slot 1970 and the engagement member 2016 may slide into the opening 2012. In one embodiment, the engagement member 2016 may include tabs that are biased outward and greater than a diameter of the opening 2012 such that the tabs engage the opening 2012 when inserted and release the opening when the tabs are pressed together. 239 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 The alignment guide 2020 includes a body 2022, an inferior end 2024, and superior end 2026 and one or more openings 2028 near the superior end 2026. The openings 2028 may be aligned. A surgeon may use the alignment guide 2020 by engaging the coupler 2010 to couple the alignment guide 2020 to the cutting guide 1900. Next, a surgeon may insert one or more K-wires through the openings. The openings 2028 and alignment guide 2020 may be configured such that K-wires within the openings extend along an anterior-posterior axis and indicate the orientation and alignment of the first cuneiform 210 and first metatarsal 230 once the osteotomy procedure is completed. A surgeon may compare this alignment with the orientation and alignment of other bones of the patient. In this manner, a surgeon can confirm that osteotomy procedure will accomplish the desired outcome once completed. 240 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 Figures 22A-22H are top perspective, top, bottom, front elevation, rear elevation, right, left, and alternative top perspective, respectively, of a patient-specific cutting guide 2200 according to one embodiment. The cutting guide 2200 may be designed to facilitate resection of a first cuneiform near a distal end and a first metatarsal near a proximal end with planar cuts at the proper angles to provide dual-plane correction of the orientation of the first metatarsal relative to the first cuneiform, thereby providing correction in a lateral direction, in a plantar direction, and/or a dorsal direction. 241 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 As shown, the cutting guide 2200 may have a body 2210 with a monolithic construction and the general shape of a rectangular shape. The body 2210 includes a proximal side 2212, a distal side 2214, a medial side 2216, a lateral side 2218, a superior side 2220, and an inferior side 2222. In the illustrated embodiment, the body 2210 may also include a proximal arm 2230 that extends from the body 2210 and a distal arm 2240 that extends from the body 2210. The proximal side 2212 is the side closest to the core of the patient when the cutting guide 2200 is in use. The distal side 2214 is the side furthest from the core of the patient when the cutting guide 2200 is in use. The medial side 2216 is the side facing medially when the cutting guide 2200 is in use. The lateral side 2218 is the side facing laterally when the cutting guide 2200 is in use. The superior side 2220 is the side facing up away from the bone(s) when the cutting guide 2200 is in use. The inferior side 2222 is the side facing down, facing, and/or contacting the bone(s) (e.g., contacting a surface of one or more bones) when the cutting guide 2200 is in use. 242 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 The inferior side 2222 may be custom contoured to match the shapes of one or more of the surfaces of the first cuneiform and/or the first metatarsal. In one embodiment, the inferior side 2222 may include a bone engagement surface 2224. The bone engagement surface 2224 can be shaped to match a first surface of a first bone and a second surface of a second bone of a joint. 243 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 In one example, the bone engagement surface 2224 can be shaped such that the bone engagement surface 2224 matches a surface of a cuneiform bone and a surface of a metatarsal bone of a tarsometatarsal (“TMT”) joint. The bone engagement surface 2224 can be so shaped because it is fabricated from a bone model of the patient’s bones. The body 2210 is configured, designed, and/or fabricated to seat transverse to a joint (e.g., a TMT joint) with the bone engagement surface 2224 engaging a first surface of a first bone and a second surface of a second bone. 244 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 Figures 22A-22H includes similar components, parts, devices, apparatus, features, and aspects as those disclosed and described in relation to Figures 19A-19H, however the difference in Figures 22A-22H is that body 2210, bone engagement surface 2224, and/or one or more arms (e.g., proximal arm 2230 and/or distal arm 2240) are configured to couple to the bones and extend transverse to the joint, at least partially, if not completely, on the dorsal sides of the bones. Accordingly, the cutting guide 2200 may be referred to as a dorsal cutting guide. 245 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 In addition, the cutting guide 2200 may be configured to avoid contact with soft tissue such as nerves, tendons, blood vessels, and the like that may run along a medial and/or a lateral side of the first metatarsal 230. Accordingly, the cutting guide 2200 may be fabricated to seat transverse to the TMT joint such that the bone engagement surface contacts a dorsal surface of the a first bone (e.g., first cuneiform 210) and/or a second bone (e.g., first metatarsal 230). For example, the proximal arm 2230 and/or distal arm 2240 may be positioned more laterally than in other embodiments. 246 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 In the illustrated embodiment, the body 2210 is configured to reside on the dorsal surfaces of the first cuneiform and the first metatarsal to provide proper alignment of the body 2210 with the metatarsocuneiform joint (e.g., the joint between the first metatarsal and the medial cuneiform bone, aka a TMT joint). In another embodiment, the body 2210 is configured to reside or sit between the medial surfaces and the dorsal surfaces for an osteotomy. 247 Added by DJM 2 2022 2/25/22, 12:00 AM

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