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Delete 		PER-24 What is claimed is: 459 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In particular, the curved osteotomy is formed by a pattern of a plurality of openings arranged in a curve within the body of the second resection guide 1824. In the illustrated embodiment, the pattern is a downward curve shape. 384 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 The curved osteotomy is determined, at least partially, based on a bone model of at least a portion of the patient's ankle. The bone model is based on medical imaging of the patient's ankle. Those of skill in the art will appreciate that a curved osteotomy and an angled curved osteotomy are formed by a first resection feature 1864 and/or a second resection feature 1866 having a trajectory in relation to the a bone to be resected that matches or substantially matches the angle that the curved osteotomy and/or angled curved osteotomy will have once a cutting tool is used to form the curved osteotomy and/or angled curved osteotomy by way of the first resection feature 1864 and/or a second resection feature 1866. 385 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In the illustrated embodiment, by forming a bone tunnel in the bone aligned with each of the plurality of openings in the second resection feature 1866, and then interconnecting the bone tunnels, a curved shape (like a dome) can be formed on an end or within a bone of a patient. The bone tunnels can be interconnected by angling a burr cutting tool within one opening in one direction and/or the other (e.g., medially and/or laterally). In one embodiment, the openings of the plurality of openings have a diameter that permits a burr cutting tool to be moved in a way to interconnect bone tunnels. Alternatively, or in addition, the bone tunnels can be interconnected by using an osteotome to remove walls between adjacent bone tunnels. 386 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In the illustrated embodiment, a curved osteotomy may refer to an osteotomy formed using from a lateral side or a medial side of an ankle of a patient. (e.g., lateral approach or medial approach). When using this approach a curved osteotomy can be formed in which the osteotomy extends into the bone (e.g., tibia 226 and/or talus 222) at a second angle 1898 (See FIG. 21D) that is perpendicular to a mechanical axis 880 of the bone being resected (e.g., tibia 226 or talus 222). The second angle 1898 may be measured based on a trajectory for how the curved osteotomy extends into the bone within the frontal plane 264. Such a curved osteotomy may be referred to as a straight cut. Alternatively, or in addition, instead of a curved osteotomy, resection guides 1820 may each include resection features for forming angled curved osteotomies. 387 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In one embodiment, the first angle 1896 and the second angle 1898 are determined at least partially based on a bone model of at least a portion of a patient’s ankle. Advantageously, a surgeon can define and/or determine the values for the first angle 1896 and/or second angle 1898. 388 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 For example, a surgeon may provide these values in a set of user instructions 604. Alternatively, or in addition, the surgeon may review an initial version of an osteotomy system 1800, and based on that review may revise the first angle 1896 and/or second angle 1898. In one embodiment, a preoperative plan can show a surgeon either through an animation and/or a series of images and/or a text description a condition of an ankle and bones of a patient before the osteotomies with one version of an osteotomy system 1800 and a position and/or alignment of the bones and/or ankle after completion of osteotomies using the osteotomy system 1800 and reducing the bones. Accordingly, a surgeon can review the planned positioning and outcome and review the first angle 1896 and/or second angle 1898. Based on the surgeon’s professional judgment, the surgeon may decide to revise the first angle 1896 and/or second angle 1898. Alternatively, or in addition, a surgeon may confirm the settings and/or values for the first angle 1896 and/or second angle 1898. For example, after reviewing a preoperative plan with the first angle 1896 and/or second angle 1898 set at a particular set of angles. 389 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In another embodiment, a surgeon may request that two or more resection guides 1820 be fabricated for the osteotomy system 1800 with the intention of using particular resection guides 1820 (i.e., a subset of the two or more resection guides 1820) during the surgical procedure and making the final decision intraoperatively. For example, two or more of the resection guides 1820 may be configured to form angled curved osteotomies using a different first angle 1896. 390 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIGs. 19A-19G illustrate different views of one example first resection guide 1822. In one embodiment, the first resection guide 1822 includes a body 1902 that includes an anterior side 1904, a posterior side 1906, a medial side 1908, a lateral side 1910, a superior side 1912, and an inferior side 1914. Generally, the sides of the first resection guide 1822 refer to the direction the sides face when the first resection guide 1822 is in use. FIG. 19A is an anterior perspective view of one example first resection guide 1822. FIG. 19B is lateral view of the example first resection guide 1822 of FIG. 19A. FIG. 19C is a medial view of the example first resection guide 1822 of FIG. 19A. FIG. 19D is a posterior view of the example first resection guide 1822 of FIG. 19A. FIG. 19E is an anterior view of the example first resection guide 1822 of FIG. 19A. FIG. 19F is a superior view of the example first resection guide 1822 of FIG. 19A. FIG. 19G is an inferior view of the example first resection guide 1822 of FIG. 19A. FIGs. 19C, 19D, 19E, 19F, and 19G include views of the bone engagement surface 1832. In certain embodiments, the first resection guide 1822 can include one or more landmark registration features 1834. 391 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Those of skill in the art will appreciate that one objective in using the resection guides 1820 can be to form a curved osteotomy and/or an angled curved osteotomy. There are a number of ways to configure the resection guides 1820 to reach this objective. In one embodiment, a trajectory for resection of bone can be controlled and/or managed by an angle of the first resection feature 1864 and/or second resection feature 1866 through a body of the resection guide 1820. 392 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Alternatively, whereas in the present disclosure, a resection guide 1820 can be fabricated with a bone facing side (e.g., medial side 1908) that is contoured to a shape, size, contour, and configuration of a surface of the bone, those of skill in the art will appreciate that first resection feature 1864 and/or second resection feature 1866 may extend perpendicular through a body of the resection guide 1820. However, a change in the resection trajectory can be accomplished by changing a distance between a non-bone facing side surface (e.g., lateral side 1910) and a bone facing side (e.g., medial side 1908) surface of a body of the resection guide 1820 such that one end of a resection guide 1820 is closer to the bone than the other side when the resection guide 1820 is deployed. Thus, by varying the depth of the body across the bone facing side (e.g., medial side 1908) of the body, a designer can cause the a resection feature to contact the bone at a desired angle (e.g., first angle 1896 and/or second angle 1898). 393 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIGs 19A-19C illustrate that the example first resection guide 1822 includes one or more stabilizers 1892 and one or more sights 1894. In the example first resection guide 1822 the bone attachment features 1828 are configured such that holes/openings in the body 1902 are parallel to each other and therefore the pins deployed into these holes are also parallel to each other. Having parallel pins can be advantageous because the parallel pins can enable the first resection guide 1822 to be readily removed by sliding the body 1902 off of the pins. In this manner, the pins can remain in the bone(s) and can serve as reference features. However, the parallel pins can also result in the body 1902 being unstable and moving too much during the osteotomy. For example, the body 1902 may move away from the bone(s) along the pins (a translation referred to as riding up). 394 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Accordingly, to retain the advantages of parallel pins for the bone attachment features 1828 and provide a stable first resection guide 1822, the first resection guide 1822 can include one or more stabilizers 1892. In one embodiment, a stabilizer 1892 is an opening in the body 1902 configured to accept a pin deployed through the opening and into the bone(s). Advantageously, the opening extends through the body 1902 at an oblique angle relative to the angle that openings for one or more bone attachment features 1828 pass through the body. This angle pin of the stabilizer 1892 ensures that the body 1902 remains stable against the bone(s) for the osteotomy. Of course, the first resection guide 1822 can include one or more stabilizers 1892. 395 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 The sights 1894 serve to assist a surgeon in reviewing, confirming, and/or validating a position of the first resection guide 1822 relative to other anatomical structures of the patient (e.g., bones). In one embodiment, sights 1894 are used during a surgical procedure and can be used together with medical imaging to check position, alignment, trajectory, or the like. In one embodiment, a surgeon may provisionally position the first resection guide 1822 and then use flouroscopy to visually check or confirm a position of the first resection guide 1822 relative to another bone or other bones of the patient. In certain embodiments, the flouroscopy machine (e.g., C-arm) can include reference features that key off of certain markers or anatomical features of the patient to ensure that the flouroscopy image is the view desired for the surgeon. A surgeon may use the flouroscopy machine and locate a sight 1894 to determine whether or not the first resection guide 1822 is in a desired position. In one embodiment, the flouroscopy machine may include a scope or view finder or corresponding sight (e.g., cross hairs) that a surgeon can align with the sight 1894 to do a visual check and/or confirmation of the position of the first resection guide 1822. After this visual check, a surgeon may secure the first resection guide 1822 to one or more bones of the patient (i.e., deploy pins in bone attachment features 1828). 396 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In the illustrated embodiment, the sights 1894 is implemented as an opening having a predefined diameter, an opening that is positioned in a predetermined location of the body 1902 and that extends from a lateral side 1910 to a medial side 1908 of the body 1902. In the illustrated embodiment, the sight 1894 also aligns with the alignment guide 1874 and/or a shaft 1878 deployed in the alignment guide 1874. In one embodiment, a sight 1894 can include cross-hairs positioned in the center of the sight 1894. 397 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIG. 19B illustrates that the first resection guide 1822 can include one or more bone engagement features 1830. These bone engagement features 1830 can each include a bone engagement surface 1832. As described herein, the number, size, and/or configuration of the bone engagement features 1830 can be determined based, at least in part, on a user instructions 604. 398 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIGs. 20A-20G illustrate different views of one example second resection guide 1824. In one embodiment, the second resection guide 1824 includes a body 2002 that includes an anterior side 2004, a posterior side 2006, a medial side 2008, a lateral side 2010, a superior side 2012, and an inferior side 2014. Generally, the sides of the second resection guide 1824 refer to the direction the sides face when the second resection guide 1824 is in use. FIG. 20A is lateral view of the example second resection guide 1824 of FIG. 20A. FIG. 20B is a medial view of the example second resection guide 1824 of FIG. 20A. FIG. 20C is a posterior view of the example second resection guide 1824 of FIG. 20A. FIG. 20D is an anterior view of the example second resection guide 1824 of FIG. 20A. FIG. 20E is a superior view of the example second resection guide 1824 of FIG. 20A. FIG. 20F is an inferior view of the example second resection guide 1824 of FIG. 20A. FIG. 20G is an anterior lateral perspective view of the example second resection guide 1824. FIG. 20H is an anterior medial perspective view of the example second resection guide 1824. 399 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIGs. 20B-20F and 20H include views of the bone engagement surface 1832. In certain embodiments, the second resection guide 1824 can include one or more landmark registration features 1834. 400 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Those of skill in the art will appreciate that one objective in using the resection guides 1820 can be to form a curved osteotomy and/or an angled curved osteotomy. There are a number of ways to configure the resection guides 1820 to reach this objective. In one embodiment, a trajectory for resection of bone can be controlled and/or managed by an angle of the first resection feature 1864 and/or second resection feature 1866 through a body of the resection guide 1820. 401 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Alternatively, whereas in the present disclosure, a resection guide 1820 can be fabricated with a bone facing side (e.g., medial side 2008) that is contoured to a shape, size, contour, and configuration of a surface of the bone, those of skill in the art will appreciate that first resection feature 1864 and/or second resection feature 1866 may extend perpendicular through a body of the resection guide 1820. However, a change in the resection trajectory can be accomplished by changing a distance between a non-bone facing side (e.g., lateral side 2010) surface and a bone facing side (e.g., medial side 2008) surface of a body of the resection guide 1820 such that one end of a resection guide 1820 is closer to the bone than the other side when the resection guide 1820 is deployed. Thus, by varying the depth of the body across the bone facing side (e.g., medial side 2008) of the body, a designer can cause the a resection feature to contact the bone at a desired angle (e.g., first angle 1896 and/or second angle 1898). 402 Added by DJM Jan 2024 1/6/24, 10:01 PM

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