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Delete 		PER-12 Advantageously in certain embodiments, the present disclosure can be used to prepare a preoperative plan, one or more instruments, implants, or guides, including implants and/or guides that are patient-specific, and/or to perform one or more osteotomies on any body part of a patient. 275 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 Figure 18 illustrates a couple of examples of osteotomies that can be performed. In particular, the present disclosure can be used to perform wedge osteotomies. 276 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 Figure 19 illustrates an exemplary osteotomy system 1900, according to one embodiment. The osteotomy system 1900 can include one or more fasteners 1910, one or more resection guides 1920, and one or more complementary components 1930. While an osteotomy system 1900 can be used for any osteotomy procedure, one or more features, components, and/or aspects of the osteotomy system 1900 may be particularly suited for a wedge osteotomy, an Evans osteotomy, a Kouts osteotomy, or the like. 277 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 In certain embodiments, the one or more fasteners 1910 can include both one or more permanent fasteners and one or more temporary fasteners. Typically, the fasteners 1910 may be used during a variety of different steps of procedure. Temporary fasteners are often used because they can securely hold bone or parts of bones well steps of the procedure are conducted. A common temporary fastener that can be used with osteotomy systems 1900 is a K-wire, also referred to as a pin. 278 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 The one or more resection guides 1920 assist a surgeon in performing different resection steps for an osteotomy procedure. In certain embodiments, a resection guide 1920 includes one or more resection features 1922 and one or more bone attachment features 1924. The resection features 1922 can take a variety of forms and/or embodiments. Similarly, the bone attachment features 1924 can take a variety of forms and/or embodiments. The resection features 1922 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 bone attachment features 1924 serve to secure the resection guide 1920 to one or more bones and/or one or more other structures. Often, a bone attachment features 1924 can include a hole in the resection guide 1920 together with a temporary fastener such as a K-wire or pin. 279 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 In certain embodiments, a resection guide 1920 may include one or more bone engagement surfaces 1926 and/or one or more landmark registration features 1928. "Landmark registration features" refers to a structure configured to engage with a feature, aspect, attribute, or characteristic of a first object to orient and/or position a second object that includes the landmark registration feature with respect to the first object. A variety of structures can serve as a landmark registration feature. For example, a landmark registration feature may include a protrusion, a projection, a tuberosity, a cavity, a void, a divot, a tab, an extension, a hook, a curve, or the like. Similarly, a variety of structures can serve as a landmark that engages with a landmark registration feature. For example, in the context of a bone, a landmark may include head, neck, condyle, epicondyle, tuberosity, tubercle, crest, spine, process, trochanter, linea, fossa, foramen, notch, groove or sulcus, a protrusion, a projection, a tuberosity, a cavity, a void, a divot, a tab, an extension, a hook, a curve, a surface of a bone such as a medial surface, a lateral surface, an anterior surface, a posterior surface, a plantar surface, or the like. 280 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 In certain embodiments, the bone engagement surface 1926 are patient-specific – contoured to match a surface of one or more bones the resection guide 1920 contacts during the osteotomy procedure. Alternatively, or in addition, the bone engagement surface 1926 may not be patient-specific and may, or may not, contact a bone surface during use of the resection guide 1920. Those of skill in the art appreciate that one or more sides of any of the members of the osteotomy system 1900 may include one or more bone engagement surfaces 1926. Consequently, one or more sides of the fasteners 1910, the resection guide(s) 1920, the complementary components 1930, one or more pin guides 1994, and/or the implants 1996 may include one or more bone engagement surfaces 1926. 281 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 The complementary components 1930 serve to assist a surgeon during one or more steps of an osteotomy procedure. Those of skill in the art appreciate that a number of components can serve as complementary components 1930. Examples of complementary components 1930 include, but are not limited to, an alignment guide 1940, a rotation guide 1950, a correction guide 1960, a compression guide 1970, a positioning guide 1980, a fixation guide 1990, one or more pin guides 1994, and one or more implants 1996. In general, the complementary components 1930 serve to assist a surgeon in performing the function included in the name of the complementary component 1930. Thus, an alignment guide 1940 can help a surgeon align bones, parts of bones, or other parts of a patient as part of an osteotomy procedure. A rotation guide 1950 can help a surgeon rotate one or more bones, parts of bones, or other parts of a patient as part of an osteotomy procedure. 282 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 A correction guide 1960 can help a surgeon position and/or orient one or more bones, parts of bones, or other parts of a patient as part of an osteotomy procedure in order to reduce the bone, bones, bone parts, or other parts and/or in order to correct a position and/or orientation of the bone, bones, bone parts, or other parts. A compression guide 1970 can help a surgeon compress one or more bones, parts of bones, or other parts of a patient together or against an implant as part of an osteotomy procedure. A positioning guide 1980 can help a surgeon position one or more bones, parts of bones, or other parts of a patient as part of an osteotomy procedure. In certain embodiments, the positioning guide 1980 may be designed and fabricated to be patient-specific. The patient-specific aspects can include a patient-specific bone engagement surface, a predefined angle for reorienting one or more bone or bone parts within one or more planes, a predefined position for bone attachment features 1924 or fasteners 1910, or the like. Alternatively, or in addition, the positioning guide 1980 may be selected from a kit, collection, or repository of a number of positioning guides 1980: each having a different configuration for one or more aspects/attributes of the positioning guide 1980. For example, each member of the repository/kit may include a different positioning angle (repositioning or correction angle), the angles may differ by 2 degrees for example. In such an embodiment, each positioning guide 1980 may not be patient-specific to a particular patient, but may provide the desired amount of positioning to meet the goals of the surgeon. In certain embodiments, a preoperative plan generated based on the present disclosure may include a recommendation for the positioning guide 1980 to be used, even if the recommended positioning guide 1980 is not patient-specific to the particular patient. 283 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 A fixation guide 1990 can help a surgeon in completing one or more temporary or permanent fixation steps for one or more bones, parts of bones, or other parts of a patient as part of an osteotomy procedure. One or more pin guides 1994 serve to guide a surgeon in deployment of one or more pins (e.g., K-wires) for use in a surgical procedure. In one embodiment, the one or more pin guides 1994 may engage with, and/or reference for position and/or trajectory off of one or more resection guides 1920 and/or any of the complementary components 1930. In one embodiment, one or more pin guides 1994 may be configured to enable (or facilitate) deployment of one or more pins at a predefined distance, offset, and/or trajectory relative to another component of the osteotomy system 1900 and/or one or more osteotomies formed during a surgical procedure. In another embodiment, one or more pin guides 1994 may be configured to enable (or facilitate) deployment of one or more pins at a patient-specific distance, offset, and/or trajectory relative to another component of the osteotomy system 1900 and/or one or more osteotomies formed during a surgical procedure. The patient-specific distance, offset, and/or trajectory may be predetermined to satisfy the needs of a patient and/or a surgeon. 284 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 One example of a complementary components 1930 may include the compressor / distractor 1000. The compressor / distractor 1000 can be used to compress or distract bones or parts of bones involved in an osteotomy procedure. 285 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 Advantageously, the osteotomy system 1900 can help a surgeon overcome one or more of the challenges in performing an osteotomy procedure, particularly on bones of a foot of a patient, such as on the forefoot, midfoot, or hindfoot. One challenge during an osteotomy procedure can be maintaining control of and/or position and/or orientation of a bone, one or more bones, and/or bone pieces/fragments, particular once a resection is performed. Advantageously, the fasteners 1910, resection guide 1920, and/or complementary components 1930 can be configured to assist in overcoming this challenge. 286 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 Advantageously, the osteotomy system 1900 can help a surgeon in positioning, placing, and/or orienting a resection guide accurately. Modern techniques may include preoperative planning, simulation, or even practice using computer models, virtual reality systems, augmented reality systems or the like. However, simulations and models are still different from positioning a resection guide on a patient’s bone, joint, or body part during the procedure. The osteotomy system 1900 can include a number of features to assist the surgeon with the positioning. In one embodiment, the resection guide 1920 can include one or more landmark registration features 1928. 287 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 Advantageously, the osteotomy system 1900 can help a surgeon in securing guides of the osteotomy system 1900, such as a resection guide, as well as how to readily remove the guide (e.g., resection guide) without disturbing a reduction, shifting, reorienting, or repositioning one or more bones or parts of bones while removing the guide. In certain embodiments, the osteotomy system 1900 is configured to permit removal of a guide while keeping temporary fasteners in place for use in subsequent steps of an osteotomy procedure. Alternatively, or in addition, the osteotomy system 1900 facilitates positioning of temporary fasteners during one step of the wedge osteotomy procedure for use in a subsequent step of the wedge osteotomy procedure. Removal of a guide during an osteotomy procedure can be particularly challenging where translation and/or rotation of the bones involved in the wedge osteotomy procedure is required for the success of the wedge osteotomy procedure. Advantageously, the osteotomy system 1900 accommodates translation and/or rotation of the bones during the wedge osteotomy procedure while facilitating a successful outcome for the wedge osteotomy procedure. 288 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 Advantageously, the components of the osteotomy system 1900 can be specifically designed for a particular patient. Alternatively, or in addition, the components of the osteotomy system 1900 can be specifically designed for a class of patients. Each of the components of the osteotomy system 1900 can be designed, adapted, engineered and/or manufactured such that each feature, attribute, or aspect of the component is specifically designed to address one or more specific indications present in a patient. Advantageously, the cuts made for the osteotomy procedure can be of a size, position, orientation, and/or angle that provides from an optimal osteotomy with minimal risk of undesirable resection. In one embodiment, the components of the osteotomy system 1900 can be configured such that an osteotomy is performed that enables a correction in more than one plane in relation to the parts of the body of the patient. For example, cut channels in a resection guide 1920 can be oriented and configured such that when the bones are fused/fixated the correction results from translation, rotation, and/or movement of bones or bone parts in two or more planes (e.g., sagittal and transverse). 289 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 In certain embodiments, the components of the osteotomy system 1900 may be made as small as possible to minimize the amount of soft tissue that is opened in the patient for the osteotomy procedure. Alternatively, or in addition, walls and/or sides of the components may be beveled and/or angled to avoid contact with other hard tissue or soft tissues in the operating field for the osteotomy procedure. 290 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 Those of skill in the art will appreciate that for certain wedge osteotomy procedure a complementary components 1930 may not be needed or a given complementary components 1930 may be optional for use in the wedge osteotomy procedure. Similarly, those of skill in the art will appreciate that certain features of the fasteners 1910, resection guides 1920, and/or complementary components 1930 can be combined into one or more of apparatus or devices or may be provided using a plurality of separate devices. 291 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 Dwyer osteotomy 292 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 Figure 20 illustrates an exemplary osteotomy system 2000 for a Dwyer osteotomy, according to one embodiment. In one embodiment, an osteotomy system 2000 may include a resection guide 2020 (two embodiments 2020a, 2020b) and at least one complementary component 1930. In such an embodiment, the resection guide 2020 and/or the at least one complementary component 1930 may include a patient-specific feature. In one embodiment, the osteotomy system 2000 includes at least one complementary component 1930 selected from a group of complementary components 1930. Examples of members of the group, include, but are not limited to, an alignment guide, a rotation guide, a compression guide, a correction guide, a positioning guide, a pin guide, a fixation guide, and the like. One or more of the guides that are included in the at least one complementary component 1930 can include a patient-specific feature, including but not limited to, a bone engagement surface, a bone attachment feature, a resection feature, a landmark registration feature, a handle, or the like. 293 Added by DJM Jan 2024 1/6/24, 10:03 PM
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Delete 		PER-12 In certain embodiments, a single complementary component 1930 may be configured to perform functions of two or more other components in the group of at least one complementary component 1930. The other components may be combined because of aspects identified in one or more bone models of one or more bones of a patient and may be combined to form a patient-specific component. Alternatively, or in addition, other components may be combined to reduce the number of instruments used or required for a surgical procedure and/or to reduce the number of steps in a surgical procedure. Furthermore in certain embodiments, osteotomy system 2000 may be configured and designed first in a virtual environment together with a surgical technique that minimizes the number of complementary component 1930 used or needed and/or the number of steps in the surgical technique. For example, the resection guide 2020 and/or at least one fastener 2010 and/or complementary component 1930 may cooperate with each other to provide instruments (that may or may not include patient-specific aspects) and a surgical technique that provides a favorable outcome for the patient and places a least amount of pressure on the surgeon. 294 Added by DJM Jan 2024 1/6/24, 10:03 PM

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