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Delete 		PER-20 As also shown in FIG. 13, method 1300 may include inserting a cutting tool into the metatarsal resection feature to create an osteotomy of the metatarsal (block 1316). For example, a surgeon may insert a cutting tool into the metatarsal resection feature to create an osteotomy of the metatarsal, as described above. 304 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 As further shown in FIG. 13, method 1300 may include sliding a positioning guide over the two proximal guide pins and the two distal guide pins until the positioning guide contacts the cuneiform and the metatarsal, where the positioning guide causes a cut face of the osteotomy of the cuneiform to contact a cut face of the osteotomy of the metatarsal (block 1318). For example, a surgeon may slide a positioning guide over the two proximal guide pins and the two distal guide pins until the positioning guide contacts the cuneiform and the metatarsal, where the positioning guide causes a cut face of the osteotomy of the cuneiform to contact a cut face of the osteotomy of the metatarsal, as described above. 305 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 As also shown in FIG. 13, method 1300 may include deploying fixation secured the cuneiform to the metatarsal (block 1320). For example, a surgeon may deploy fixation to secure the cuneiform to the metatarsal, as described above. 306 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 Method 1300 may include additional implementations, such as any single implementation or any combination of implementations described below and/or in connection with one or more other methods or processes described elsewhere herein. In a first implementation, the distal resection guide may include a first distal resection guide configured such that sliding the first distal resection guide further may include replacing the first distal resection guide with a second resection guide. The second resection guide may be configured to guide resection of the metatarsal at an angle that extends more distal from a proximal end of the metatarsal than the metatarsal resection feature of the first distal resection guide. 307 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 Although FIG. 13 shows example blocks or steps of a process 1300, in some implementations, A method 1300 may include additional steps, fewer steps, different steps, or differently arranged steps than those depicted in FIG. 13. Additionally, or alternatively, two or more of the steps of a method 1300 may be performed in parallel. 308 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 FIGS. 14A-14F illustrate different views of one or more stages in a surgical procedure that includes one or more embodiments of the present disclosure. Reference is made to FIGS. 8, 9A-D, 14A-14F and FIG. 13. In the illustrated embodiment, the metatarsal is a patient’s first metatarsal 208. 309 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 FIG. 14A illustrates a stage of the method 1300 in which a navigation guide (e.g., navigation guide 840, navigation guide 900, navigation guide 1000) is being deployed 1302 onto a TMT between a medial cuneiform 202 and a first metatarsal 208. In the illustrated embodiment, the surgeon has made an incision that permits placement of the navigation guide 840 on a first TMT of a patient. The set of proximal guide pins 928 and set of distal guide pins 930 are also illustrated and will be deployed shortly. 310 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 FIG. 14B illustrates a stage in the surgical procedure in which the navigation guide has been placed in a desired position across the TMT. Advantageously, a surgeon may leverage a bone engagement surface and/or bone engagement opening of the navigation guide to position the navigation guide where needed. Once the navigation guide is in place, a surgeon deploys 1304 a set of proximal guide pins 928 into a set of proximal holes 924 and a set of distal guide pins 930 into a set of distal holes 926. In this manner, markers of the navigation guide have been used to position the set of proximal guide pins 928 (a proximal reference feature on a medial cuneiform 202) and the set of distal guide pins 930 (a distal reference feature on a first metatarsal 208). In one embodiment, before deploying the set of proximal guide pins 928 and set of distal guide pins 930, a surgeon may use fluoroscopy to check the position of the navigation guide relative to the parts of the bone. Advantageously, at this stage the set of proximal guide pins 928 and the set of distal guide pins 930 are positioned for use in subsequent stages. Next, a surgeon may operate 1306 a coupler or severe a frangible portion of the navigation guide to separate the set of proximal guide pins 928 from the set of distal guide pins 930 and remove 1308 the navigation guide. In one embodiment, a surgeon may remove the bolt 962 to operate the coupler. 311 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 In one embodiment, FIG. 14C illustrates the TMT after method step 1308 is completed. The navigation guide has been removed. The set of proximal guide pins 928 are positioned in the medial cuneiform 202 and the set of distal guide pins 930 are positioned in the first metatarsal 208. The initial and accurate positioning of the set of proximal guide pins 928 and the set of distal guide pins 930 can be an important step in a surgical procedure because other steps and/or instruments may rely on accurate positioning of these pins to perform their respective desired functions and aspects. A surgeon can now proceed with the procedure with confidence that the reference features will provide accurate guidance that corresponds to the preplanned and desired correction, based on the medical imaging of the patient’s foot. 312 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 Unfortunately, the fidelity and accuracy of these models is not as advanced with respect to the modeling of soft tissue of a patient such as sinews, skin, tendons, ligaments, muscles, fat, and the like. Thus, rehearsal of a surgical procedure, particularly one that includes translating and/or reorienting one or more bone fragments has limited benefit. In such cases, because the surgeon cannot predict or know beforehand how much movement and reorientation the soft tissue of a patient will permit, the surgeon needs to be able to revise or adapt a surgical procedure intraoperatively to achieve optimal outcomes. The system, apparatus, and methods of the present disclosure enable a surgeon to make intraoperative adjustments to surgical plan based on what the surgeon learns during the surgery. 168 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 The present disclosure leverages the use of models, such as computer models, and particularly models of a specific patient to provide and/or generate instrumentation, implants, and/or surgical plans that advanced patient care. Advantageously, these models are unique and customized for a particular patient. Thus, the models reflect the actual anatomical features and aspects of the patient. 169 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 However, the utility and helpfulness of the models, methods, systems, and/or apparatuses of FIGS 3-5, is dependent on how effectively a surgeon can navigate within, on, or in relation to one or more anatomical references or anatomical features of a patient such that the steps of the surgical procedure can be performed on a patient in the same manner as those modeled using models of the anatomy of the patient. This process of navigation is referred to as a mapping or translation between the virtual or model environment to a physical or real world environment that includes the patient anatomy and the operating field. 170 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 Advantageously, the models, methods, systems, and/or apparatuses of the present disclosure facilitate mapping or translating between a virtual or model environment and/or instrumentation to a physical or real world environment for a surgical procedure. The present disclosure provides this feature or benefit by providing an apparatus, system, and method, that enables a surgeon to identify, create, form, and/or use reference feature for a surgical procedure. The reference feature provides a reference and/or starting point on, in, or associated with anatomy of a patient such that steps, stages, features, or aspects planned and configured within the model can be accurately performed on, with, or to the anatomy of the patient. In certain embodiments, one or more steps of a surgical procedure can be done in connection with or in relation to the reference feature. 171 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 The reference feature facilitates moving from one coordinate system or frame of reference in a virtual environment to a position, location, frame of reference, environment, or orientation on, or in, an actual object, structure, device, apparatus, anatomical structure, or the like. Advantageously, the reference feature can coordinate objects, models, or structures in a digital or virtual model or representation with corresponding objects or structures (e.g., anatomical structures) of actual physical objects or structures. Said another way, the reference feature can serve to map from a virtual or modeled object to an actual or physical object. 172 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 Advantageously, the embodiment of the present disclosure include features and aspects that assist a surgeon in locating at least one reference feature, which can then be used in one or more stages of a surgical procedure. In certain embodiments, the actual instruments fabricated using the present disclosure may include one or more references (e.g., a model references). The one or more model instruments may use the one or more references to position and/or orient the one or more model instruments such that other steps of a surgical procedure can be performed in relation to those one or more model instruments and/or model references. Certain model references may key off or related to anatomical references of modeled anatomical body parts. The reference feature(s) correspond to the model references and together enable a surgeon to identify reference features on actual anatomy of a patient for a surgical procedure. 173 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 FIGS. 6A and 6B illustrate a couple of examples of a mapping between a virtual model and physical anatomy of a patient’s foot. FIG. 6A illustrates a model or virtual pane 610 and an actual or physical pane 620. 174 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 The virtual pane 610 illustrates a view and/or representation of one or more models of bones of a specific patient. Models of soft tissue are not shown for clarity and to facilitate the description. Alternatively, or in addition, as explained above, models of soft tissue are not as reliable as desired for use in planning the surgical procedure. The virtual pane 610 includes a bone model 404 that includes a model of a medial cuneiform 202, a model of a first metatarsal 208, a model of a second metatarsal 210, etc. Virtual pane 610 illustrates that the foot 200 has a deformity. Specifically, the first metatarsal 208 extends more medial than desired; the first metatarsal 208 is not substantially parallel to the second metatarsal 210. 175 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 The physical pane 620 illustrates a view of one or more actual bones of a specific patient. Soft tissue is not shown for clarity and to facilitate the description. The physical pane 620 illustrates actual bones of the same patient used to create the models of virtual pane 610. Physical pane 620 shows a medial cuneiform 202, a first metatarsal 208, a second metatarsal 210, etc. Physical pane 620 shows the patient’s foot 200 has a deformity. Specifically, the first metatarsal 208 extends more medial than desired; the first metatarsal 208 is not substantially parallel to the second metatarsal 210. 176 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 The virtual pane 630, like virtual pane 610 illustrates a view and/or representation of one or more models of bones of this specific patient. Models of soft tissue are not shown. The virtual pane 630 includes the same models as virtual pane 610 and illustrates the foot 200 after the deformity has been addressed. Specifically, the model of the first metatarsal 208 extends more parallel to the model of the second metatarsal 210 than before. 177 Added by DJM Jan 2024 1/6/24, 10:06 PM
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Delete 		PER-20 The physical pane 640, like physical pane 620 illustrates a view of the same actual bones as physical pane 620. Physical pane 640 shows the patient’s foot 200 after the deformity has been addressed. Specifically, the first metatarsal 208 extends more parallel to the second metatarsal 210 than before. 178 Added by DJM Jan 2024 1/6/24, 10:06 PM

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