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Delete 		PER-24 FIG. 21D illustrates one example of how the first resection feature 1864 and/or second resection feature 1866 can be configured to form a curved osteotomy and an angled curved osteotomy. In the illustrated embodiment, the first resection guide 1822 includes a first resection feature 1864 that guides a cutting tool to resect at least part of a talus 222 at a second angle 1898. Note that the second angle 1898 is perpendicular to the mechanical axis 880 (and parallel to a medial-lateral axis ML). The first resection feature 1864 enables a surgeon to form a curved osteotomy that can be referred to as a “straight cut”. The curved osteotomy curves within the sagittal plane 262 and extends into the bone parallel with the ML axis. 423 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In the illustrated embodiment, the second resection guide 1824 includes a second resection feature 1866 that guides a cutting tool to resect at least part of a tibia 226 at a first angle 1896. Note that the first angle 1896 is not perpendicular (i.e., is oblique) to the mechanical axis 880 (and to a medial-lateral axis ML). The second resection feature 1866 enables a surgeon to form an angled curved osteotomy that can be referred to as an “angled cut”. The curved osteotomy curves within the sagittal plane 262 and extends into the bone at an angle in relation to the ML axis. 424 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Said another way, the first resection feature 1864 extends perpendicularly from the medial side 1908 of the first resection guide 1822 to the lateral side 1910 of the first resection guide 1822 at the second angle 1898 and the second resection feature 1866 extends from the medial side 2008 of the second resection guide 1824 to the lateral side 2010 of the second resection guide 1824 at the first angle 1896. 425 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In one embodiment, FIG. 21E illustrates a stage in which a first resection guide 1822 and a second resection guide 1824 have been removed. A curved osteotomy (e.g., first osteotomy) has been formed at the proximal end of the talus 222 and an angled curved osteotomy (e.g., second osteotomy) has been formed at the distal end of the tibia 226. The curved osteotomy and the angled curved osteotomy are reduced at the resection interface 884. Advantageously, a minimal amount of bone of the talus 222 and/or the tibia 226 has been removed and a stable, complete reduction is achieved. Note reference features, fixation pins, permanent and/or temporary fixation is omitted from the view in FIG. 21E but may be included in certain embodiments and/or may be added to hold the reduction place for healing and fusion. 426 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIG. 21E illustrates that the first angle 1896 and second angle 1898 have been selected, determined, defined (e.g., using bone models of the patient) such that reduction of the curved osteotomy and the angled curved osteotomy remediates a deformity of the patient. Note that in comparing FIGs. 21D to 21E, the alignment and/or position of the calcaneus 224 has been changed and the calcaneus 224 has been translated more in line with the mechanical axis 880 of the tibia 226. A first dome osteotomy (i.e., curved osteotomy) and a second dome osteotomy (i.e., angled curved osteotomy) have been brought together to provide a deformity correction. Those of skill in the art will appreciate that forming the curved osteotomy and/or the angled curved osteotomy without the aid of the first resection guide 1822 and/or second resection guide 1824 may have required resection of the bone(s) by manual free-hand. Advantageously, the reduction and subsequent fusion using the first resection guide 1822 and/or second resection guide 1824 can result in a more satisfactory fusion of an ankle joint. 427 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In one embodiment, a stop 886 can be implemented in the form of a distance of a resection feature 826 between an opening on an anterior side 838, 852 and an opening on the posterior side 840, 854. In one embodiment, a portion of the body 836,850 may be of a predetermined length just around the resection features 826, Alternatively, or in addition, the whole body may have the predetermined length to provide the stop 886. Those of skill in the art will appreciate the one or the other or both of the resection feature 826 may include this type of stop. 293 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Alternatively, or in addition, another structure may be formed at or near the resection feature 826 and serve as a stop 886. In this format, the distance within the resection feature 826 combined with a particular length for the blade or bur of the cutting tool may serve as a stop 886. Advantageously, a surgeon using such a configured resection guides 820 need not check or monitor the depth when forming the osteotomy. The surgeon can simply insert the cutting tool until the tool abuts the resection feature 826 of the resection guide 820 (“bottoms out”). At this point, the surgeon knows the cutting tool has reached a prescribed depth and that tissue beyond the depth is preserved. 294 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In the illustrated embodiment, a resection guard 870 is positioned at each end of the resection feature 826 of the tibial resection guide 822 and at each end of the resection feature 826a of the resection guard 870. Of course, the resection guard 870 may be positioned at other points within, along, or near the resection features 826. Advantageously, because the resection guides 820 can be manufactured to meet a specific patient’s anatomy, more precise placement and/or orientation of resection guards 870 can enable preservation of a joint of the patient and/or avoid resection of adjacent structure within the area of the joint. Those of skill in the art will appreciate that the use of one or more resection guards 870 may be optional and may depend on the user instructions 604 as to whether resection guards 870 are included, where they are positioned, oriented, and/or used. 295 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Advantageously, the osteotomy system 800 can include a plurality of stops 886 and/or resection guards 870 that can assist a surgeon during the cutting in or between any of the planes of the foot and/or ankle. These stops 886 are configured to prevent a cutting tool from cutting tissue beyond a boundary defined at least partially using a bone model of at least a portion of a patient's foot and/or ankle. Those of skill in the art will appreciate that as an osteotomy is formed in one or both of the resection feature 826 and resection guards 870 are being used, the osteotomy will free the resection guard 870. For certain surgeons this may be undesirable. Advantageously, a surgeon can include in the user instructions 604 that specify whether or not to include stops 886 and/or resection guards 870, how many to include, where to position them, and the like. Thus, a surgeon can control how and where stops 886 may be used. 296 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In one embodiment, the tibial resection guide 822 may include an alignment guide 874. The alignment guide 874 includes a superior end and one or more openings 876 (See FIG 9B) near the superior end. An alignment guide 874 may be coupled to, connected to, and/or extend from a tibial resection guide 822. Alternatively, or in addition, An alignment guide 874 may be coupled to, connected to, and/or extend from a talus resection guide 824. The alignment guide 874 assists a surgeon in confirming that a resection guide 820 is in a desired position relative to other anatomical structures and/or axes of a patient. In one embodiment, the alignment guide 874 indicates an orientation of a resection guides 820 relative to a mechanical axis 880 of a tibia 226 of the patient. 297 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 A surgeon may use the alignment guide 874 by inserting a shaft 878, such as a K-wire, into, or through, an opening 876. The openings 876 and alignment guide 874 may be configured such that a K-wire 878 within the opening 876 extends superiorly along a superior-inferior axis and indicates the orientation and alignment of the tibial resection guide 822 relative to a long axis or a mechanical axis 880 of the tibia 226. A surgeon may compare this alignment with a desired alignment and/or position and/or the orientation and/or alignment of other bones of the patient. In this manner, a surgeon can confirm that tibial resection guide 822 is properly positioned. 298 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In certain embodiments, the alignment guide 874 may have an opening on both ends such that the shaft 878 can extend in a dorsal/cephalad direction and in a plantar/caudal away from the alignment guide 874, the lower extension of the shaft 878 can further assist a surgeon in checking alignment. Alternatively, or in addition, the alignment guide 874 can include one or more second openings that extend perpendicular to the opening(s) 876. These second openings are horizontal to the shaft 878 and may be configured to accept a second shaft that is perpendicular to the shaft 878. This second shaft may extend medially and laterally and may cross over the shaft 878. In one embodiment, the alignment guide 874 includes an opening that extends from an anterior surface to a posterior surface and is centered on where the shaft 878 crosses over the second shaft. In this manner, the alignment guide 874 may form a kind of sight, much like a gunsight. In one embodiment, a surgeon may use this site and medical imaging such as with a C-arm (e.g., fluoroscopy) to check or confirm a position of a resection guides 820 intraoperatively. 299 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIG. 12C illustrates an alternative view of the surgical procedure similar to the stage in FIG. 12A. However, the tibia 226 and fibula 228 are transparent. FIG. 12C illustrates how a surgeon may use the shaft 878, alignment guide 874, and/or one or more of the resection guard 870 to check and/or confirm the position, placement, alignment, and/or trajectory that cuts using the resection guides 820 will have in the bones of the patient. In the illustrated embodiment, the mechanical axis 880 may be perpendicular to an anterior-posterior axis 888. In certain embodiments, the surgeon may choose to position and/or orient the resection guard 870 so that they can serve as alignment and/or positioning guides during the surgical procedure. 300 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In certain cases, a surgeon may position the tibial resection guide 822 on the tibia 226 and secure it using the bone attachment feature(s) 828. Next, the surgeon may insert the shaft 878 into the alignment guide 874 and may use flouroscopy from an anterior view and/or a lateral view to confirm the shaft 878 is parallel in the frontal plane 264 and transverse plane 266. Alternatively, or in addition, the surgeon may deploy or stage (just insert one end into holes in the resection guides 820 so that the pins are held but do not enter the bone) and then use flouroscopy from a lateral view to check that the resection guard 870 are parallel with the anterior-posterior axis 888 in the sagittal plane 262. Since the tibial resection guide 822 was positioned and/or designed using a model of at least a portion of the foot and ankle of the patient, the surgeon can be assured that the tibial resection guide 822 is in the position desired. Of course, a similar process for checking and/or confirming can be done with the talus resection guide 824 as desired. 301 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIG. 12D illustrates resection guides, according to another embodiment. In the illustrated embodiment, the resection guides 820 can include, again either by default and/or due to user instructions 604, one or more fastener guides 890. The fastener guides 890 are structures that serve to assist, facilitate, mark, and/or indicate where to position and/or place fasteners that are used independently and/or as part of a fixation system. In certain embodiments, the fastener guides 890 may be implemented as spikes or tines on a bone facing surface of the resection guides 820 that provide an opening in the bone that can be used when the resection guides 820 is pounded against the bone using a mallet. 302 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Advantageously, a surgeon can indicate in the user instructions 604 which fasteners and/or fixation systems, the surgeon plans to use. Accordingly, the tibial resection guide 822 and/or talus resection guide 824 can be designed and/or fabricated to support those fastener guides 890. 303 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 In the illustrated embodiment, the example resection guides 820 include fastener guides 890 that can be implemented as holes in the bodies of the tibial resection guide 822 and/or talus resection guide 824. These fastener guides 890 may be laid out on the resection guides 820 in a pattern that matches the one or more holes for a fastener such as one or more bone plates, one or more bone staple, one or more bone screws, or the like that a surgeon may desired to use for provisional or permanent fixation. In one embodiment, the fastener guides 890 mark where pilot holes or hole marks can be made in the bone. Alternatively, or in addition, a surgeon may deploy pins that can be used in a fixation system. In still other embodiments, a fastener guides 890 may serve to enable deployment of fixation fastener, such as a cannulated headless bone screw. Those of skill in the art will appreciate that the fastener guides 890 can take a variety of forms and configurations and leverage the positioning and placement of the resection guides 820. 304 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 Of course, the bone attachment features 828 and/or the resection guard 870 can also be strategically positioned to serve as pilot holes and/or guides for fasteners and/or components of a fixation system used when fixation is needed. 305 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIGS. 12A-12D illustrate one example of one type of osteotomy the osteotomy system 800 can be used to create during the surgical procedure. In the illustrated embodiment, a first osteotomy formed by the tibial resection guide 822 is a straight cut and a second osteotomy formed by the talus resection guide 824 is a straight cut with a straight medial connected cut. Advantageously, the surgeon, by way for example of the user instructions 604 can defined what shape, size, type, and/or trajectory of osteotomy they want the resection guide 820 to assist them in creating. Said another way, the surgeon can define the shape, size, length, and/or configuration of the resection interface 884. 306 Added by DJM Jan 2024 1/6/24, 10:01 PM
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Delete 		PER-24 FIGs. 13A-13F illustrate alternative embodiments of a resection interface between two osteotomies using an exemplary osteotomy system, according to one embodiment. As described herein, the resection interface 884 307 Added by DJM Jan 2024 1/6/24, 10:01 PM

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