Patent Publication Number: US-2022211388-A1

Title: Osteotomy guide

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims priority to international patent application no. PCT/CN2019/082425, filed Apr. 12, 2019, the teachings of which are hereby incorporated by reference as if set forth in its entirety herein. 
    
    
     TECHNICAL FIELD 
     The present disclosure relates to a surgical guide for cutting bone during an osteotomy, and methods for using the same. 
     BACKGROUND 
     The cartilage in a joint, such as a knee, can wear down over time or become damaged due to an injury related to physical activity, resulting in osteoarthritis. Wearing of the cartilage can result in pain that limits the activity of daily life. Typically, osteoarthritis was treated by implanting an artificial joint to replace the original joint. However, there are several drawbacks to full joint replacements. For instance, joint replacements often require large portions of the articular surface of the joint to be removed to accommodate fixation of a metal or polymer joint implant. Further, replacement joints often have a limited life of up to twenty years, and therefore, subsequent replacement surgeries are often needed. Yet further, joint replacements are often complicated by postoperative infection, osteolysis, and osteoporosis, which may require an additional surgery. 
     Some patients with early onset of osteoarthritis experience cartilage wear of only a portion of the articular surface, such as cartilage wear of less than all of the compartments of the joint. For example, some patients may experience bi-compartmental osteoarthritis of two compartments of the joint or uni-compartmental osteoarthritis of a single compartment of the joint. For patients with compartmental osteoarthritis, it might not be necessary to remove and replace the entire articular surface. Therefore, an osteotomy, such as a high tibial osteotomy, can be performed in patients with limited cartilage wear. For example, a medial high-tibial osteotomy can be performed for patients with medial compartmental osteoarthritis to realign the knee joint. 
     A medial high-tibial osteotomy is performed by making a cut into the patient&#39;s tibia at a location that is adjacent the proximal end of the tibia and on the medial side. The proximal end of the patient&#39;s tibia is pivoted to enlarge the cut so as to realign the weight bearing line, to balance the pressure in the knee. The proximal end of the tibia can then be fixed in position so as to maintain the enlarged cut by attaching a bone plate to the tibia. The bone plate extends across the enlarged cut and is attached to the tibia on opposed sides of the cut. In some procedures, the cut can be filled with bone graft or artificial bone before or after the plate is attached. 
     SUMMARY 
     In an example embodiment, an osteotomy guide is configured to guide cutting of a bone. The guide comprises an anterior end and a posterior end that are spaced from one another along a transverse direction. The guide comprises an inner surface configured to face bone, and an outer surface opposite the inner surface along an outer direction. Each of the inner surface and the outer surface extends between the anterior end and the posterior end. The inner surface defines i) a first bone contacting region, and ii) a second bone contacting region that is spaced from the first bone contacting region so as to define a gap therebetween. The gap extends from the first bone contacting region to the second bone contacting region, and extends from the inner surface toward the outer surface along the outer direction. The osteotomy guide comprises at least one transverse guide surface that extends between the outer surface and the inner surface, and is oriented along a transverse axis along the transverse direction so as to at least partially define a transverse cutting path into the bone. The at least one transverse guide surface is offset from the gap along a distal direction. The osteotomy guide comprises at least one ascending guide surface that extends between the outer surface and the inner surface. The ascending guide is oriented along an ascending axis along an ascending direction so as to at least partially define an ascending cutting path into the bone. The ascending direction is angularly offset from the distal direction and the transverse direction, and the ascending axis and transverse axis intersect one another. 
     In another embodiment, an osteotomy guide is configured to guide cutting of a bone. The osteotomy guide comprises an anterior end and a posterior end that are spaced from one another along a transverse direction. The osteotomy guide comprises an inner surface configured to face the bone, and an outer surface that is opposite the inner surface. At least a portion of the inner surface is contoured to face the bone. The osteotomy guide comprises first and second transverse guide surfaces that face each other so as to define a transverse groove therebetween that extends along a transverse axis along the transverse direction so as to define a transverse cutting path. The osteotomy guide comprises first and second ascending guide surfaces that face each other so as to define an ascending groove therebetween that extends along an ascending axis along an ascending direction, wherein the ascending axis and transverse axis intersect one another. 
     In yet another embodiment, an osteotomy guide is configured to guide cutting of a bone. The osteotomy guide comprises an anterior end and a posterior end that are spaced from one another along a transverse direction. The osteotomy guide comprises an inner surface configured to face bone, and an outer surface opposite the inner surface along an outer direction. Each of the inner surface and the outer surface extends between a posterior end of the osteotomy guide and an anterior end of the osteotomy guide. The inner surface defines i) a first bone contacting region, ii) a second bone contacting region that is spaced from the first bone contacting region so as to define a gap therebetween that extends from the inner surface towards the outer surface along the outer direction, and iii) a third bone contacting region that extends between the first bone contacting region and the second bone contacting region and at least partially defines the gap. The osteotomy guide comprises at least one transverse guide surface that extends between the outer surface and the inner surface, and is oriented along a transverse axis along the transverse direction so as to at least partially define a transverse cutting path into the bone. The osteotomy guide comprises at least one ascending guide surface that extends between the outer surface and the inner surface, and is oriented along an ascending axis along an ascending direction so as to at least partially define an ascending cutting path into the bone. The ascending axis and transverse axis intersect one another. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The following description of the illustrative embodiments may be better understood when read in conjunction with the appended drawings. It is understood that potential embodiments of the disclosed systems and methods are not limited to those depicted. 
         FIG. 1  shows an outer perspective view of an osteotomy guide according to one embodiment; 
         FIG. 2  shows an inner perspective view of the osteotomy guide of  FIG. 1 ; 
         FIG. 3  shows plan view of a proximal end of the osteotomy guide of  FIG. 1 ; 
         FIG. 4  shows plan view of a distal end of the osteotomy guide of  FIG. 1 ; 
         FIG. 5  shows elevation view of an inner side of the osteotomy guide of  FIG. 1 ; 
         FIG. 6  shows elevation view of an outer side of the osteotomy guide of  FIG. 1 ; 
         FIG. 7  shows elevation view of an anterior end of the osteotomy guide of  FIG. 1 ; 
         FIG. 8  shows elevation view of a posterior end of the osteotomy guide of  FIG. 1 ; 
         FIG. 9  shows a simplified block diagram of a surgical method according to one embodiment; 
         FIG. 10  shows a perspective view of a tibia and fibula with the osteotomy guide of  FIG. 1  attached to the tibia; 
         FIG. 11  shows a perspective view of the tibia, fibula, and osteotomy guide of  FIG. 10  along the posterior direction; 
         FIG. 12  shows a perspective view of the tibia, fibula, and osteotomy guide of  FIG. 10  along the anterior direction; 
         FIG. 13  shows a perspective view of the tibia, fibula, and osteotomy guide of  FIG. 10  with a cutting instrument making an ascending cut in the bone; 
         FIG. 14  shows a perspective view of the tibia, fibula, and osteotomy guide of  FIG. 10  with a cutting instrument making a transverse cut in the bone; 
         FIG. 15  shows an anterior view of the tibia and fibula of  FIG. 10  after a cut has been formed in the tibia and a fixation plate has been attached to the tibia; 
         FIG. 16  shows an outer perspective view of an osteotomy guide according to another embodiment; 
         FIG. 17  shows an inner perspective view of the osteotomy guide of  FIG. 16 ; 
         FIG. 18  shows plan view of a proximal end of the osteotomy guide of  FIG. 16 ; 
         FIG. 19  shows plan view of a distal end of the osteotomy guide of  FIG. 16 ; 
         FIG. 20  shows elevation view of an outer side of the osteotomy guide of  FIG. 16 ; 
         FIG. 21  shows elevation view of an inner side of the osteotomy guide of  FIG. 16 ; 
         FIG. 22  shows elevation view of an anterior end of the osteotomy guide of  FIG. 16 ; 
         FIG. 23  shows elevation view of a posterior end of the osteotomy guide of  FIG. 16 ; 
         FIG. 24  shows a perspective view of a tibia along with the osteotomy guide of  FIG. 16  attached to the tibia; 
         FIG. 25  shows an outer perspective view of an osteotomy guide according to yet another embodiment; 
         FIG. 26  shows an inner perspective view of the osteotomy guide of  FIG. 25 ; 
         FIG. 27  shows plan view of a proximal end of the osteotomy guide of  FIG. 25 ; 
         FIG. 28  shows plan view of a distal end of the osteotomy guide of  FIG. 25 ; 
         FIG. 29  shows elevation view of an outer side of the osteotomy guide of  FIG. 25 ; 
         FIG. 30  shows elevation view of an inner side of the osteotomy guide of  FIG. 25 ; 
         FIG. 31  shows elevation view of a posterior end of the osteotomy guide of  FIG. 25 ; 
         FIG. 32  shows elevation view of an anterior end of the osteotomy guide of  FIG. 25 ; 
         FIG. 33  shows a perspective view of a tibia along with the osteotomy guide of  FIG. 25  attached to a tibia; 
         FIG. 34  shows a perspective view of the tibia and guide of  FIG. 33  with an osteotomy cut in the tibia enlarged; 
         FIG. 35  shows a perspective view of a spacer according to one embodiment; 
         FIG. 36  shows an elevation view of one side of the spacer of  FIG. 35 ; 
         FIG. 37  shows an elevation view of another side of the spacer of  FIG. 35 ; 
         FIG. 38  shows an elevation view of a front end of the spacer of  FIG. 35 ; 
         FIG. 39  shows an elevation view of a rear end of the spacer of  FIG. 35 ; 
         FIG. 40  shows a first perspective view of a tibia with the spacer of  FIG. 35  implanted into an osteotomy cut in the tibia and with a bone plate attached to the tibia; 
         FIG. 41  shows a second perspective view of a tibia with the spacer of  FIG. 35  implanted into an osteotomy cut in the tibia and with a bone fixation plate attached to the tibia; 
         FIG. 42  shows a first perspective view of a spacer according to another embodiment; 
         FIG. 43  shows a second perspective view of the spacer of  FIG. 42 ; 
         FIG. 44  shows a plan view of a top of the spacer of  FIG. 42 ; 
         FIG. 45  shows a plan view of a bottom of the spacer of  FIG. 42 ; 
         FIG. 46  shows an elevation view of one side of the spacer of  FIG. 42 ; 
         FIG. 47  shows an elevation view of another side of the spacer of  FIG. 42 ; 
         FIG. 48  shows a perspective view of a tibia with the spacer of  FIG. 42  implanted into an osteotomy cut in the tibia; and 
         FIG. 49  shows the tibia and spacer of  FIG. 42  with a bone fixation plate attached to the tibia. 
     
    
    
     DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS 
     With general reference to  FIGS. 1 to 8 , an osteotomy guide  100  is shown according to one embodiment. The osteotomy guide  100  is configured to guide at least one cutting instrument to make a cut into a bone for an osteotomy procedure. The osteotomy guide  100  can be custom constructed to conform to a bone of a specific patient. In other words, the osteotomy guide  100  may be patient specific. The osteotomy guide  100  can be three-dimensionally (3-D) printed or can be fabricated in any other suitable manner. In at least some embodiments, the osteotomy guide  100  can include a one-piece body. The osteotomy guide  100  defines at least one ascending guide surface  134  and at least one transverse guide surface  138  (both labeled in  FIGS. 5 and 6 ) that are configured to guide at least one cutting instrument, such as a saw blade, to make a cut into a bone such as a tibia, femur, fibula, humerus, ulna, radius, or other bone. The osteotomy guide  100  can be configured to guide a cut into the bone adjacent to a joint, the cut dividing the bone into first and second bone segments, the first bone segment being closer to the joint. The cut can then be enlarged by pivoting the first segment of the patient&#39;s bone relative to the second segment of the bone so as to realign the bone. For example, the cut can be enlarged to realign the weight bearing line, to balance the pressure in the knee, although other alignment procedures are contemplated. The enlarged cut can then be fixed by attaching a bone plate that extends across the cut from the first bone segment to the second bone segment so as to affix the bone on opposed sides of the enlarged cut. For illustrative purposes, the guide  100  will be described and shown relative to its use in making a cut in a tibia. 
     Referring more specifically to  FIGS. 1 to 4 , the osteotomy guide  100  has an inner surface  102 , and an outer surface  104  opposite the inner surface  102  with respect to an outward direction D o . In other words, the inner surface  102  is opposite from the outer surface  104  with respect to an inward direction D i , where the inward direction D i  is opposite the outward direction D o . The inner surface  102  can be a bone facing surface configured to face the bone. Preferably, at least a portion of the inner surface  102  is configured to contact the bone, and thus, can be considered to be a bone contacting surface. The inner surface  102  can be contoured so as to conform to a surface of the bone. The contour can be generally concave or can be any suitable contour to match the surface of the bone. The outer surface  104  can be configured to face away from the bone. In some examples, the outer surface  104  can be substantially convex, although embodiments of the disclosure are not so limited. 
     The osteotomy guide  100  has an anterior end  106 , and a posterior end  108  opposite the anterior end  106  with respect to a posterior direction D po . In other words, the anterior end  106  is opposite the posterior end  108  with respect to an anterior direction D a , where the anterior direction D a  and posterior direction D po  are opposite one another. Note that, as used herein, the anterior and posterior directions Da and D po  together may also be referred to as a transverse direction. The osteotomy guide  100  can be configured to be positioned on the bone such that the anterior end  106  is adjacent an anterior side of the bone and the posterior end  108  is adjacent a posterior side of the bone. However, it will be understood that osteotomy guide  100  can be otherwise positioned. The anterior direction D a  and the posterior direction D po  can be perpendicular to both the inward and outward directions Din and D o . 
     The osteotomy guide  100  has a proximal end  110 , and a distal end  112  opposite the proximal end  110  with respect to a distal direction D d . In other words, the proximal end  110  is opposite the distal end  112  with respect to a proximal direction D pr , where the proximal direction D pr  and distal direction D d  are opposite one another. The osteotomy guide  100  is configured to be positioned on the bone such that the proximal end  110  is oriented towards a proximal end of the bone, and the posterior end  112  is oriented towards a distal end the bone. The proximal direction D pr  and distal direction D d  can be perpendicular to the inward direction Din, the outward direction D o , the anterior direction D a , and the posterior direction D po . 
     The inner surface  102 , and thus osteotomy guide  100 , has at least two bone contacting regions that are configured to contact the bone when the osteotomy guide  100  is positioned along the bone. Each bone contacting region can be specifically sized and shaped to a contour of the bone of a particular patient. The at least two bone contacting regions can be arranged so as to define a gap  124  therebetween. The at least two bone contacting regions can include a first bone contacting region  118 . The first bone contacting region  118  can be positioned closer to the proximal end  110  than a second bone contacting region  120  (discussed below). Thus, the first bone contacting region  118  may be considered to be a proximal bone contacting region. The first bone contacting region  118  can extend between the anterior end  106  and the posterior end  108 . For example, the first bone contacting region  118  can be elongate as it extends between the anterior end  106  and the posterior end  108 . In some embodiments, the first bone contacting region  118  can extend from the anterior end  106  to the posterior end  108 . At least a portion, up to an entirety, of the first bone contacting region  118  can be contoured as it extends between the anterior end  106  to the posterior end  108  so as to conform to the bone. The contour can be generally concave or can be any suitable contour to match the surface of the bone. A posterior end, such as a free end, of the first bone contacting region  118  can be configured (e.g., sized and shaped) to hook a holding point of the bone when the osteotomy guide  100  is affixed to the bone. As used herein, the holding point can refer to a protrusion of the bone on a medial side of the bone. 
     Additionally, or alternatively, the at least two bone contacting regions can include a second bone contacting region  120 . The second bone contacting region  120  can be offset from the first bone contacting region  118  along the distal direction D d  so as to define a gap  124  therebetween. In other words, the first bone contacting region  118  can be offset from the second bone contacting region  120  along the proximal direction D pr  so as to define a gap  124  therebetween. The second bone contacting region  120  can be positioned closer to the distal end  112  than the first bone contacting region  118 . Thus, the second bone contacting region  122  may be considered to be a distal bone contacting region. The second bone contacting region  120  can extend between the anterior end  106  and the posterior end  108 . For example, the second bone contacting region  120  can be elongate as it extends between the anterior end  106  and the posterior end  108 . In some embodiments, the second bone contacting region  120  can extend from the anterior end  106  to the posterior end  108 . At least a portion, up to an entirety, of the second bone contacting region  120  can be concave as it extends between the anterior end  106  to the posterior end  108  so as to conform to the bone. A posterior end, such as a free end, of the second bone contacting region  120  can be configured (e.g., sized and shaped) to hook the posterior ridge of the bone when the osteotomy guide  100  is affixed to the bone. 
     Additionally, or alternatively, the at least one bone facing surface can include a third bone contacting region  122 . The third bone contacting region  122  can extend between the first bone contacting region  118  and the second bone contacting region  120 . For example, the third bone contacting region  122  can extend from the first bone contacting region  118  to the second bone contacting region  120 . The third bone contacting region  122  can be elongate as it extends between the first bone contacting region  118  and the second bone contacting region  120 . The third bone contacting region  122  can be disposed at the anterior end  106  of the osteotomy guide  100 . Thus, the third bone contacting region  122  can extend between the first bone contacting region  118  and the second bone contacting region  120  at the anterior end  106 . Accordingly, the third bone contacting region  122  can be considered to be an anterior bone contacting region. The third bone contacting region  122  can be concave as it extends towards the posterior end  108 . It will be understood that, in alternative embodiments, the osteotomy guide  100  can be implemented without the third bone contacting region  122  or the third bone facing surface can extend between the first bone contacting region  118  and the second bone contacting region  120  at a location that is offset from the anterior end  106 . 
     The at least two bone contacting regions can provide a better fit on the bone than one larger bone contacting surface. For example, the gap  124  between the first bone contacting region  118  and the second bone contacting region  120  can provide space for bony protrusions to extend between the first bone contacting region  118  and the second bone contacting region  120 . 
     The osteotomy guide  100  can include an anterior body portion  126 , and a posterior body portion  128  that is offset from the anterior body portion  126  along the posterior direction D po . The anterior body portion  126  can at least partially define the anterior end  106  and can extend from the anterior end  106  towards the posterior end  108 . The posterior body portion  128  can at least partially define the posterior end  108  and can extend from the posterior end  108  towards the anterior end  106 . The osteotomy guide  100  can include a proximal wall  119  that defines the first bone contacting region  118 . The osteotomy guide  100  can include a distal wall  121  that defines the second bone contacting region  120 . The distal wall  121  can be spaced from the proximal wall  119  along the distal direction Da so as to define the gap  124  therebetween. The anterior body portion  126 , and hence the osteotomy guide  100 , can include a third wall  123  that defines the third bone contacting region  122 . The third wall  123  can extend between the proximal wall  119  and the distal wall  121 , such as from the proximal wall  119  to the distal wall  121 . The gap  124  can extend into the posterior end  108  towards the anterior end  106  such that the gap  124  is open at the posterior end  124 . The gap  124  can extend towards and terminate at, for example, the third bone contacting region  122 , such as at the third wall  123  that defines the third bone contacting region  122 . It will be understood that, in some embodiments, the gap  124  can be closed at the posterior end  124 . 
     The gap  124  extends into the inner surface  102  towards the outer surface  104 . At least a portion of the gap  124  can extend through the outer surface  104 . For example, the gap  124  can extend through the outer surface  104  at the posterior body portion  128 . In other words, at least a portion, such as an anterior portion, of the gap  124  can be open at the inner surface  102  and the outer surface  104 . At least a portion of the gap  124  can terminate at the outer surface  104 . For example, the gap  124  can terminate at the outer surface  104  at the anterior body portion  126 . Thus, at least a portion, such as an anterior portion, of the gap  124  can be open at the inner surface  102  and closed at the outer surface  104 . It will be understood that, in some embodiments, the anterior portion of the gap  124  can be open at the outer surface  104 . Additionally, or alternatively, in some embodiments, the posterior portion of the gap  124  can be closed at the outer surface  104 . In some embodiments, the gap  124  can have a dimension along the proximal direction D pr  or distal direction D d  that is greater than, or equal to, a dimension of at least one, such as both, of the first bone contacting region  118  and the second bone contacting region  118  along the same direction. 
     Referring to  FIGS. 5 to 8 , in embodiments where the gap  124  extends through the inner surface  102  and the outer surface  104 , the posterior body portion  128 , and thus osteotomy guide  100 , can include a proximal arm  130 , and a distal arm  132  that is offset from the proximal arm  130  with respect to the distal direction D d . The proximal arm  130  and the distal arm  132  can be separated from one another by the gap  124 . The proximal arm  130  can extend from the anterior body portion  126  towards the posterior end  108 . Thus, the proximal arm  130  can have a first end that is attached to the anterior body portion  126  and a second end that is spaced from the first end along the posterior direction D po . The second end can be a free end of the proximal arm  130 . Similarly, the distal arm  132  can extend from the anterior body portion  126  towards the posterior end  108 . Thus, the distal arm  132  can have a first end that is attached to the anterior body portion  126  and a second end that is spaced from the first end along the posterior direction D po . The second end can be a free end of the distal arm  132 . In some embodiments, the proximal arm  130  can be angled away from the distal arm  132  as the proximal arm  130  extends towards the posterior end  108 . It will be understood that the precise shape of each of the first and second arm may vary based on the specific curvatures of the patient&#39;s bone. 
     The proximal arm  130  can include at least a portion, such as a posterior portion, of the first bone contacting region  118 . The distal arm  132  can include at least a portion, such as a posterior portion, of the second bone contacting region  120 . The first bone contacting region  118  has a first curvature, and the second bone contacting region  120  has a second curvature that is different from the first curvature. For example, the second curvature can be greater than the first curvature. Thus, the second bone contacting region  120  can curve further inward than the first bone contacting region  118  as can be seen in  FIG. 3 . It will be understood that, in alternative embodiments, the first and second curvatures may be different from that shown and may vary based on the curvatures of a particular patient&#39;s bone. 
     With continued reference to  FIGS. 5 and 6 , the osteotomy guide  100  can have at least one ascending guide surface that is configured to guide the cutting instrument to make an ascending cut into the bone. However, it will be understood that, in alternative embodiments, the guide  100  can be devoid of an ascending guide surface. The ascending cut may be made, for example, around the tibial tuberosity behind the patellar tendon. Thus, the osteotomy guide  100  can be configured (e.g., sized and shaped) such that each of the at least one ascending guide surface is aligned with the tibial tuberosity when the osteotomy guide  100  is affixed to the bone. Each of the at least one ascending guide surface can be disposed at the anterior end  106  of the osteotomy guide  100 . 
     The at least one ascending guide surface can include a first ascending guide surface  134 . The first ascending guide surface  134  can extend along an ascending axis AA that extends along an ascending direction so as to at least partially define a transverse cutting path into the bone. The ascending direction is angularly offset with respect to the proximal direction D pr  and the transverse direction. For example, the ascending direction can extend at an angle that is between the proximal direction D pr  and the transverse direction. Thus, the first ascending guide surface  134  can be angled towards the anterior direction D a  as the first ascending guide surface  134  extends towards the proximal end  110 . The third wall  123  can define the first ascending guide surface  134 . 
     In some embodiments, the at least one ascending guide surface can include a second ascending guide surface  136  that is offset from the first ascending guide surface  134  so as to define an ascending groove  114  therebetween. The second ascending guide surface  136  can extend along the ascending axis AA that extends along the ascending direction so as to at least partially define an ascending cutting path into the bone. Thus, the second ascending guide surface  136  can be angled towards the anterior direction Da as the second ascending guide surface  134  extends towards the proximal end  110 . At least a portion of the first ascending guide surface  134  can face the second ascending guide surface  136  so as to define the ascending groove  114  therebetween. The ascending groove  114  can be configured to guide a cutting instrument to make an ascending cut into the bone. In some embodiments, the second ascending guide surface  136  can be substantially parallel to the first ascending guide surface  134 . The first ascending guide surface  134  can have a length along the ascending direction that is greater than that of the second ascending guide surface  136 , although embodiments of the disclosure are not so limited. 
     In embodiments having the second ascending guide surface  136 , the osteotomy guide  100  can include an ascending leg  135  that defines the second ascending guide surface  136 . The ascending leg  135  can have a first end that is attached to the anterior body portion  126 , and a second end that is offset from the first end along the ascending direction. The ascending leg  135  can be integral and monolithic with the anterior body portion  126 , although embodiments of the disclosure are not so limited. The second end can be a free end that is free from attachment to the anterior body portion  126  or any other portion of osteotomy guide  100 . The ascending groove  114  can extend into osteotomy guide  100  along a descending direction opposite the ascending direction. As such, a proximal end of the ascending groove  114  can be open, and a distal end of the ascending groove  116  can be closed, where the distal end is offset from the proximal end along the descending direction. It will be understood that, in alternative embodiments, the ascending groove  114  can terminate adjacent to the first end or can be open at both the first and second ends. 
     The osteotomy guide  100  can have at least one transverse guide surface that is configured to guide a cutting instrument to make a transverse cut into the bone. Each transverse guide surface can be disposed at the distal end  112  of the osteotomy guide  100 . Each transverse guide surface can be offset from the gap  124  with respect to the distal direction D o . For example, each transverse guide surface can be offset from the second bone contacting region  120  with respect to the distal direction D o . 
     The at least one transverse guide surface can include a first transverse guide surface  138 . The first transverse guide surface  138  can extend along a transverse axis A T  that extends along the anterior direction D a  and the posterior direction D po  (herein, collectively referred to as the transverse direction) so as to at least partially define a transverse cutting path into the bone. The ascending axis AA and transverse axis A T  can intersect one another. 
     In some embodiments, the at least one transverse guide surface can include a second transverse guide surface  140  that is offset from the first transverse guide surface  138  so as to define a transverse groove  116  therebetween. The second transverse guide surface  140  can extend along the transverse axis A T  that extends along the transverse direction so as to at least partially define the transverse cutting path into the bone. At least a portion of the first transverse guide surface  138  can face the second transverse guide surface  140  so as to define the transverse groove  116  therebetween. The transverse groove  116  can be configured to guide a cutting instrument to make a transverse cut into the bone. The cutting instrument may be the same as, or different from, the cutting instrument used to make the ascending cut. In some embodiments, the second transverse guide surface  140  can be substantially parallel to the first transverse guide surface  138 . The first transverse guide surface  138  can have a length along the posterior direction D po  that is greater than that of the second transverse guide surface  140 , although embodiments of the disclosure are not so limited. 
     In embodiments having the second transverse guide surface  140 , the osteotomy guide  100  can include a transverse leg  139  that defines the second transverse guide surface  140 . The transverse leg  139  can have a first end that is attached to the anterior body portion  126  at a bridge  137 , and a second end that is offset from the first end along the posterior direction D op . The transverse leg  139  can be integral and monolithic with the anterior body portion  126 , although embodiments of the disclosure are not so limited. The second end can be a free end that is free from attachment to the anterior body portion  126  or any other portion of the osteotomy guide  100 . The transverse groove  116  can extend into the osteotomy guide  100  along the anterior direction. As such, a posterior end of the transverse groove  116  can be open, and an anterior end of the transverse groove  116  can be closed, where the posterior end is offset from the anterior end along the posterior direction D po . It will be understood that, in alternative embodiments, the transverse groove  116  can terminate adjacent to the first end or can be open at both the first and second ends. 
     As can be seen in  FIGS. 5 and 6 , the bridge  137  separates the ascending groove  114  from the transverse groove  116 . As such, when the ascending cut and transverse cut are made in the bone, the bridge  137  can obstruct the cutting of the segment of the bone that joins the ascending cut and transverse cut and that underlies the bridge  137 . In this example, the bridge  137  obstructs the transverse cut. Thus, the first transverse guide surface  138 , and consequently the transverse cutting groove  116 , terminates such that it does not intersect the ascending cutting groove  114 . As such, the transverse cut may need to be extended after the osteotomy guide  100  is removed so as to join the transverse cut to the ascending cut. 
     The osteotomy guide  100  can define at least one fixation hole that extends through the osteotomy guide  100 . Each fixation hole can be configured to receive a fixation pin, such as a Kirschner wire, therethrough so as to affix the osteotomy guide  100  to the bone. Each fixation hole can extend through the inner surface  102  and the outer surface  104  of the osteotomy guide  100 . It will be understood that the locations of the fixation holes can vary from the embodiment shown. 
     In one example, the at least one fixation hole can include a proximal fixation hole  142  that is offset from the first bone contacting region  118  with respect to the proximal direction D pr . The osteotomy guide  100  can include a neck  144  that extends from the anterior body portion  126  along the proximal direction D pr . The proximal fixation hole  142  can extend through the neck  144 . The neck  144  can have an inner surface  145  that is configured to face the bone. The inner surface  145  of the neck  144  can be offset with respect to the proximal bone facing surface with respect to the outward direction D o . Consequently, when the proximal bone facing surface is aligned with the bone, the inner surface  145  of the neck  144  can be spaced from the bone so as to accommodate soft tissue between the inner surface  145  and the bone. Further, the proximal fixation hole  142  can correspond to a location of a hole of the bone fixation plate that is to be affixed to the bone. Thus, proximal fixation hole  142  can act as a guide for forming a hole in the bone that is used for both (i) a fixation pin that secures the osteotomy guide  100  to the bone and (ii) a bone anchor that affixes the bone fixation plate to the bone after the cut in the bone has been enlarged. 
     The at least one fixation hole can include at least one, such as two, distal bone fixation holes  146  and  148 . Each distal bone fixation hole  146  and  148  can be offset from the proximal bone fixation hole  142  with respect to the distal direction D d . Each distal bone fixation hole  146  and  148  can extend through the anterior body portion  126  of the osteotomy guide  100 . In embodiments having first and second distal bone fixation holes  146  and  148 , the first distal bone fixation hole  146  can be spaced from the second distal bone fixation hole  148  along the anterior direction D a . The first and second distal bone fixation holes  146  and  148  can be aligned along a direction that is substantially parallel with the at least one transverse guide surface  138 . 
     The osteotomy guide  100  can be a unitary body having the anterior body portion  126 , the proximal arm  130 , the distal arm  132 , the ascending leg  135 , and the transverse leg  139 . For example, the anterior body portion  126 , the proximal arm  130 , the distal arm  132 , the ascending leg  135 , and the transverse leg  139  can be integral and monolithic with one another. In one such example, the osteotomy guide  100  can be 3-D printed as a single monolithic body. Forming the osteotomy guide  100  as a single monolithic body can limit costs of 3-D printing the osteotomy guide  100  and can simplify the manufacturing process. In alternative embodiments, various components of the osteotomy guide  100  can be affixed, such as glued, welded, fastened, or otherwise coupled to, the anterior body portion  126 . Providing the osteotomy guide  100  as a unitary body can simplify handling of the osteotomy guide  100  and improve cutting accuracy over conventional guides that include two or more movable parts where stability of the movable parts can be difficult to maintain. 
     In one embodiment, a method of fabricating the osteotomy guide  100  can include obtaining a 3-D computer model of the patient&#39;s anatomy. This obtaining step can comprise receiving the 3-D computer model in a computer. Additionally, or alternatively, this obtaining step can comprise obtaining at least one image, such as a plurality of images, of the patient&#39;s anatomy using an imaging machine, such as a CT or MRI scan, and generating the 3-D computer model of the patient&#39;s anatomy from the image. The method can comprise a step of generating a 3-D computer model of the osteotomy guide  100  that conforms to the patient&#39;s anatomy. The method can comprise a step of 3-D printing the osteotomy guide  100  based on the 3-D computer model of the osteotomy guide  100 . 
     Turning now to  FIGS. 9 to 14 , a surgical method  300  will now be described. It will be understood that various steps of the surgical method can be performed by different health-care professionals. Accordingly, the surgical method can be divided into various sub-methods that can be performed separately of one another. The method can comprise an incision step  402  that comprises making an incision in the patient to access the patient&#39;s bone  300 . The method can comprise an alignment step  404  that comprises aligning the osteotomy guide  100  onto the bone  300 . For example, the alignment step  404  can comprise covering the posterior end (e.g., free end) of the first bone contacting region  118  around a holding point  304  of the bone  300 . The alignment step  404  can comprise hooking the posterior end (e.g., free end) of the second bone contacting region  120  around the posterior ridge  302  of the bone  300 . The alignment step  404  can comprise aligning the at least one ascending guide surface  134  and/or groove  114  with the tibial tuberosity  306 . When the first bone facing surface is aligned with the bone  300 , the inner surface  145  of the neck  144  can be spaced from the bone  300  as shown in  FIG. 11  so as to accommodate soft tissue between the inner surface  145  and the bone  300 . 
     With the osteotomy guide  100  aligned, the osteotomy guide  100  can be affixed to the bone  300  in step  406 . The affixation step  406  can comprises inserting a fixation pin, such as a Kirschner wire, through at least one fixation hole in the osteotomy guide and into the bone. For example, the fixation step  406  can comprise inserting a fixation pin  202  through at least one proximal fixation hole  142  and into the bone  300 . The fixation step  406  can comprise inserting a fixation pin through at least one distal fixation hole and into the bone  300 . For example, the fixation step  406  can comprise inserting a fixation pin  204  through the first distal fixation hole  146  and into the bone  300 . The fixation step  406  can comprise inserting a fixation pin  206  through a second distal fixation hole  148  and into the bone  300 . 
     The method  400  can comprise a step  408  of verifying that the osteotomy guide  100  is positioned correctly. The verifying step  408  can comprise using x-ray for fluoroscopy to verify the position of the osteotomy guide  100 . The method  400  comprises making the ascending portion  308  (labeled in  FIG. 15 ) of the cut  307  into the bone (step  410 ) as shown in  FIG. 13 , and making the transverse portion  310  (labeled in  FIG. 15 ) of the cut  307  into the bone  300  (step  412 ) as shown in  FIG. 14 . Step  410  can be performed before or after step  412 . The ascending cut  308  and the transverse cut  310  can be each made with a cutting instrument such as a saw blade  208 , and can be made with the same cutting instrument or with different cutting instruments. In one embodiment, the saw blade  208  can have a proximal end (not shown) that attaches to the saw, and a distal end  210  that is offset from the saw along an insertion direction Din. The saw blade  208  can be elongate from its proximal end to its distal end  210 , and can have a cutting edge at its distal end  210 . The saw can oscillate the blade  208  along a direction that is perpendicular to the insertion direction Din, and can cut into the bone  300  along the insertion direction Din. The depth of the saw blade  208  can be controlled using depth markings on the saw blade  208 , using a stop attached to the saw blade  208 , or using any other suitable technique. To accommodate the cutting instrument, the at least one distal fixation pin  204  and  206  can be bent out of the path of the cutting instrument as shown in  FIGS. 13 and 14 . The bend of the fixation pins  204  and  206  can further secure the osteotomy guide  100  to the bone  300 . 
     With specific reference to  FIGS. 11 and 15 , the method can comprise, after cutting the bone  300 , a step  414  of removing the osteotomy guide  100 . Step  414  can comprise removing the at least one distal fixation pin  204  and  206  before or after removing the osteotomy guide  100 . The proximal fixation pin  202  can optionally be left in place. After removing the osteotomy guide  100 , the method can comprise enlarging the cut  307  in the bone so as to realign bone. For example, the cut can be enlarged to realign the weight bearing line, to balance the pressure in the knee, although other alignment procedures are contemplated. The enlarging step  416  can comprise using a cutting instrument, such as a chisel or saw, to further enlarge the cut  307  so as to enable a proximal portion  312  of the bone  300  to pivot relative to a distal portion of the bone  314 , where the proximal and distal portions  312  and  314  of the bone  300  are separated by the cut  307 . For example, when cutting the ascending portion  308  and the transverse portion  310  of the cut  307 , the cut might not be made through the portion of the bone that underlies the bridge  137  of the osteotomy guide  100 . Therefore, after the osteotomy guide  100  is removed, a cutting instrument can be used to extend the transverse portion  310  of the cut  307  to the ascending portion  308  of the cut  307 . Once cutting is complete, the cut divides the bone into first and second bone segments  300   a  and  300   b , the first bone segment  300   a  being closer to the joint than the second bone segment  300   b . The enlarging step  414  can comprise enlarging the opening formed by the cut  307  by moving, such as rotating or translating, the first bone segment  300   a  away to the second bone segment  300   b . Enlarging the cut  307  can comprise inserting wedges (discussed below) or other instruments, such as a distractor instrument, into the cut  307  so as to achieve a desired correction angle of the articular surface of the joint. 
     After enlarging the cut  307 , a bone fixation plate  250  can be affixed to the proximal portion  312  and the distal portion  314  of the bone  300  in step  418  so as to maintain the cut  307  in the enlarged position. In one embodiment, step  418  can comprise aligning the bone fixation plate  250  with the bone  300  by receiving a fixation hole  252  of the bone fixation plate  250  over the proximal fixation pin  202  (if the fixation pin  202  were left in place as described above). The bone fixation plate  250  can be affixed to the bone  300  by inserting bone anchors through the bone fixation plate  250  and into the proximal portion  312  and distal portion  314  of the bone  300 . In step  420 , the incision can be closed. 
     Turning now to  FIGS. 16 to 24 , an osteotomy guide  500  is shown according to another embodiment. The osteotomy guide  500  is configured to guide at least one cutting instrument to make a cut into a bone for an osteotomy procedure. The osteotomy guide  500  can be custom constructed to conform to a bone of a specific patient. In other words, the osteotomy guide  500  may be patient specific. The osteotomy guide  500  can be three-dimensionally (3-D) printed or can be fabricated in any other suitable manner. In at least some embodiments, the osteotomy guide  500  can include a one-piece body. The osteotomy guide  500  defines at least one ascending guide surface  534  and at least one transverse guide surface  538  (both labeled in  FIGS. 20 and 21 ) that are configured to guide at least one cutting instrument, such as a saw blade, to make a cut into a bone such as a tibia, femur, fibula, humerus, ulna, radius, or other bone. The osteotomy guide  500  can be configured to guide a cut into the bone adjacent to a joint, the cut dividing the bone into first and second bone segments, the first bone segment being closer to the joint. The cut can then be enlarged by pivoting the first segment of the patient&#39;s bone relative to the second segment of the bone so as to realign the bone. For example, the cut can be enlarged to realign the weight bearing line, to balance the pressure in the knee, although other alignment procedures are contemplated. The enlarged cut can then be fixed by attaching a bone plate that extends across the cut from the first bone segment to the second bone segment so as to affix the bone on opposed sides of the enlarged cut. For illustrative purposes, the guide  500  will be described and shown relative to its use in making a cut in a tibia. 
     Referring more specifically to  FIGS. 16 to 19 , the osteotomy guide  500  has an inner surface  502 , and an outer surface  504  opposite the inner surface  502  with respect to an outward direction D o . In other words, the inner surface  502  is opposite from the outer surface  504  with respect to an inward direction D i , where the inward direction D i  is opposite the outward direction D o . The inner surface  502  can be a bone facing surface configured to face the bone. Preferably, at least a portion of the inner surface  502  is configured to contact the bone, and thus, can be considered to be a bone contacting surface. The inner surface  502  can be contoured so as to conform to a surface of the bone. The contour can be generally concave or can be any suitable contour to match the surface of the bone. The outer surface  504  can be configured to face away from the bone. In some examples, the outer surface  504  can be substantially convex, although embodiments of the disclosure are not so limited. 
     The osteotomy guide  500  has an anterior end  506 , and a posterior end  508  opposite the anterior end  506  with respect to a posterior direction D po . In other words, the anterior end  506  is opposite the posterior end  508  with respect to an anterior direction D a , where the anterior direction D a  and posterior direction D po  are opposite one another. Note that, as used herein, the anterior and posterior directions D a  and D po  together may also be referred to as a transverse direction. The osteotomy guide  500  can be configured to be positioned on the bone such that the anterior end  506  is adjacent an anterior side of the bone and the posterior end  508  is adjacent a posterior side of the bone. However, it will be understood that osteotomy guide  500  can be otherwise positioned. The anterior direction D a  and the posterior direction D po  can be perpendicular to both the inward and outward directions D in  and D o . 
     The osteotomy guide  500  has a proximal end  510 , and a distal end  512  opposite the proximal end  510  with respect to a distal direction D d . In other words, the proximal end  510  is opposite the distal end  512  with respect to a proximal direction D pr , where the proximal direction D pr  and distal direction D a  are opposite one another. The osteotomy guide  500  is configured to be positioned on the bone such that the proximal end  510  is oriented towards a proximal end of the bone, and the posterior end  512  is oriented towards a distal end the bone. The proximal direction D pr  and distal direction D a  can be perpendicular to the inward direction D in , the outward direction D o , the anterior direction D a , and the posterior direction D po . 
     The inner surface  502 , and thus osteotomy guide  500 , has at least two bone contacting regions that are configured to contact the bone when the osteotomy guide  500  is positioned along the bone. Each bone contacting region can be specifically sized and shaped to a contour of the bone of a particular patient. The at least two bone contacting regions can be arranged so as to define a gap  524  therebetween. The at least two bone contacting regions can include a first bone contacting region  518 . The first bone contacting region  518  can be positioned closer to the anterior end  506  than a second bone contacting region  520  (discussed below). Thus, the first bone contacting region  518  may be considered to be an anterior bone contacting region. The first bone contacting region  518  can extend between the proximal end  510  and the distal end  512 . For example, the first bone contacting region  518  can be elongate as it extends between the proximal end  510  and the distal end  512 . At least a portion, up to an entirety, of the first bone contacting region  518  can be contoured as it extends in a direction between the anterior end  506  to the posterior end  508  so as to conform to the bone. The contour can be generally concave or can be any suitable contour to match the surface of the bone. 
     Additionally, or alternatively, the at least two bone contacting regions can include a second bone contacting region  520 . The second bone contacting region  520  can be offset from the first bone contacting region  518  along the posterior direction D po  so as to define a gap  524  therebetween. In other words, the first bone contacting region  518  can be offset from the second bone contacting region  520  along the anterior direction D a  so as to define the gap  524  therebetween. The second bone contacting region  520  can be positioned closer to the posterior end  508  than the first bone contacting region  518 . Thus, the second bone contacting region  520  may be considered to be a posterior bone contacting region. The second bone contacting region  520  can extend between the proximal end  510  and the distal end  512 . For example, the second bone contacting region  520  can be elongate as it extends between the proximal end  510  and the distal end  512 . At least a portion, up to an entirety, of the second bone contacting region  520  can be concave as it extends in a direction between the proximal end  510  and the distal end  512  so as to conform to the bone. The contour can be generally concave or can be any suitable contour to match the surface of the bone. 
     Additionally, or alternatively, the at least one bone facing surface can include a third bone contacting region  522 . The third bone contacting region  522  can extend along the posterior direction D po . The third bone contacting region  522  can be elongate as it extends along the posterior direction D po . The third bone contacting region  522  can extend between the first bone contacting region  518  and the second bone contacting region  520 . In one example, the third bone contacting region  522  can extend from the first bone contacting region  518  to at least the second bone contacting region  520 , and in some examples, beyond the first bone contacting region  518 . The third bone contacting region  522  can be disposed closer to the distal end  512  of the osteotomy guide  100  than the proximal end  510 . Accordingly, the third bone contacting region  522  can be considered to be a second bone contacting region. The third bone contacting region  522  can be concave as it extends in a direction from the anterior end  506  towards the posterior end  508 . The contour can be generally concave or can be any suitable contour to match the surface of the bone. A posterior end, such as a free end, of the third bone contacting region  522  can be configured (e.g., sized and shaped) to hook a holding point of the bone when the osteotomy guide  100  is affixed to the bone. 
     The at least two bone contacting regions can provide a better fit on the bone than one larger bone contacting surface. For example, the gap  524  between the first bone contacting region  518  and the second bone contacting region  520  can provide space for bony protrusions to extend between the first bone contacting region  518  and the second bone contacting region  520 . 
     The osteotomy guide  500  can include an anterior body portion  526 , and a posterior body portion  528  that is offset from the anterior body portion  526  along the posterior direction D po . The anterior body portion  526  can at least partially define the anterior end  506  and can extend from the anterior end  506  towards the posterior end  508 . The posterior body portion  528  can at least partially define the posterior end  508  and can extend from the posterior end  508  towards the anterior end  506 . The anterior body portion  526  can include the first bone contacting region  518 . The posterior body portion  528  can include the second bone contacting region  520 . The osteotomy guide  500  can define a gap  524  between the first bone contacting region  518  and the second bone contacting region  520 . The gap  524  can extend from the proximal end  510  towards the distal end  512 . The gap  524  can extend towards and terminate at, for example, the third bone contacting region  522 . The gap  524  can extend into the proximal end  510  such that the gap  524  is open at the proximal end  510 ; however, it will be understood that, in some embodiments, the gap  524  can be closed at the proximal end  510 . 
     The gap  524  extends into the inner surface  502  towards the outer surface  504 . At least a portion of the gap  524 , such as a first portion, can extend through the outer surface  504 . In other words, at least a first portion of the gap  524  can be open at the inner surface  502  and the outer surface  504 . The first portion of the gap  524  can extend from the proximal end  510  towards the distal end  512 . The first portion of the gap  524  can also extend from a posterior end of the gap  524  towards an anterior end of the gap  524  along the anterior direction D a . A second portion of the gap  524  can terminate at the outer surface  504  such that the gap  524  is closed at the outer surface  504 . The second portion can extend from the anterior end of the gap  524  towards the posterior end of the gap  524  along the posterior direction D po , such as to the first portion. The second portion can also extend from a distal end of the gap  524  towards a proximal end of the gap  524 , such as to the first portion. It will be understood that, the gap  524  can be alternatively configured. For example, an entirety of the gap  524  can be open at the outer surface  504  or closed at the outer surface  504 . Alternatively, the first and second portions of the gap  524  can have configurations other than that shown. 
     Referring to  FIGS. 20 and 21 , in embodiments where the gap  524  extends through the inner surface  502  and the outer surface  504 , the osteotomy guide  500  can include a first arm  530 , and a second arm  532  that is offset from the first arm  530  with respect to the posterior direction D po . The first arm  530  and the second arm  532  can be separated from one another by the gap  524 . The anterior body portion  526  can include the first arm  530 . The first arm  530  can include the first bone contacting region  518 . The posterior body portion  528  can include the second arm  532 . The second arm  532  can include the second bone contacting region  520 . The second arm  532  can extend between the posterior end  508  and the gap  524 . The second arm  532  can extend from the proximal end  510  towards the distal end  512 . The second arm  532  can include an edge  533  that can be used to verify correct positioning of the osteotomy guide  500 . The edge  533  can at least partially define the gap  524 . The edge  533  can extend along a direction that extends from the proximal end  510  towards the distal end  512 . The edge  533  can be configured to abut the bone when the osteotomy guide  500  is properly positioned along the bone. The edge  533  can be configured to be viewed through the gap  524  to verify that the edge  533  abuts the bone and no space exists between the edge  533  and the bone. 
     With continued reference to  FIGS. 20 and 21 , the osteotomy guide  500  can have at least one ascending guide surface that is configured to guide the cutting instrument to make an ascending cut into the bone. However, it will be understood that, in alternative embodiments, the guide  100  can be devoid of an ascending guide surface. The ascending cut may be made, for example, around the tibial tuberosity behind the patellar tendon. Thus, the osteotomy guide  500  can be configured (e.g., sized and shaped) such that each of the at least one ascending guide surface is aligned with the tibial tuberosity when the osteotomy guide  500  is affixed to the bone. Each of the at least one ascending guide surface can be disposed at the anterior end  506  of the osteotomy guide  500 . 
     The at least one ascending guide surface can include a first ascending guide surface  534 . The first ascending guide surface  534  can extend along an ascending axis AA that extends along an ascending direction so as to at least partially define an ascending cutting path into the bone. The ascending direction is angularly offset with respect to the proximal direction D pr  and the transverse direction (e.g., the anterior and posterior directions D a  and D po ). For example, the ascending direction can extend at an angle that is between the proximal direction D pr  and the transverse direction. Thus, the first ascending guide surface  534  can be angled towards the anterior direction D a  as the first ascending guide surface  534  extends towards the proximal end  510 . The first arm  530  can define the first ascending guide surface  534 . 
     In some embodiments, the at least one ascending guide surface can include a second ascending guide surface  536  that is offset from the first ascending guide surface  534  so as to define an ascending groove  514  therebetween. The second ascending guide surface  536  can extend along an ascending axis AA that extends along the ascending direction so as to at least partially define an ascending cutting path into the bone. Thus, the second ascending guide surface  536  can be angled towards the anterior direction D a  as the second ascending guide surface  534  extends towards the proximal end  510 . At least a portion of the first ascending guide surface  534  can face the second ascending guide surface  536  so as to define the ascending groove  514  therebetween. The ascending groove  514  can be configured to guide a cutting instrument to make an ascending cut into the bone. In some embodiments, the second ascending guide surface  536  can be substantially parallel to the first ascending guide surface  534 . The first ascending guide surface  534  can have a length along the ascending direction that is greater than that of the second ascending guide surface  536 , although embodiments of the disclosure are not so limited. 
     In embodiments having the second ascending guide surface  536 , the osteotomy guide  500  can include an ascending leg  535  that defines the second ascending guide surface  536 . The ascending leg  535  can have a first end that is attached to the anterior body portion  526  at a bridge  537 , and a second end that is offset from the first end along the ascending direction. The ascending leg  535  can be integral and monolithic with the anterior body portion  526 , although embodiments of the disclosure are not so limited. The second end can be a free end that is free from attachment to the anterior body portion  526  or any other portion of osteotomy guide  500 . The ascending groove  514  can extend into osteotomy guide  500  along a descending direction opposite the ascending direction. As such, a proximal end of the ascending groove  514  can be open, and a distal end of the ascending groove  516  can be closed, where the distal end is offset from the proximal end along the descending direction. It will be understood that, in alternative embodiments, the ascending groove  514  can terminate adjacent to the first end or can be open at both the first and second ends. 
     The osteotomy guide  500  can have at least one transverse guide surface that is configured to guide a cutting instrument to make a transverse cut into the bone. Each transverse guide surface can be disposed at the distal end  512  of the osteotomy guide  500 . Each transverse guide surface can be offset from the gap  524  with respect to the distal direction D o . For example, each transverse guide surface can be offset from the third bone contacting region  522  with respect to the distal direction D o . 
     The at least one transverse guide surface can include a first transverse guide surface  538 . The first transverse guide surface  538  can extend along a transverse axis A T  that extends along the anterior direction D a  and the posterior direction D po  (herein, collectively referred to as the transverse direction) so as to at least partially define a transverse cutting path into the bone. The ascending axis AA and transverse axis A T  can intersect one another. 
     In some embodiments, the at least one transverse guide surface can include a second transverse guide surface  540  that is offset from the first transverse guide surface  538  so as to define a transverse groove  516  therebetween that extends along the transverse axis. The second transverse guide surface  540  can extend along the transverse axis A T  that extends along the transverse direction. At least a portion of the first transverse guide surface  538  can face the second transverse guide surface  540  so as to define the transverse groove  516  therebetween. The transverse groove  516  can be configured to guide a cutting instrument to make a transverse cut into the bone. The cutting instrument may be the same as, or different from, the cutting instrument used to make the ascending cut. In some embodiments, the second transverse guide surface  540  can be substantially parallel to the first transverse guide surface  538 . The first transverse guide surface  538  can have a length along the posterior direction D po  that is greater than that of the second transverse guide surface  540 , although embodiments of the disclosure are not so limited. 
     In embodiments having the second transverse guide surface  540 , osteotomy guide  500  can include a transverse leg  539  that defines the second transverse guide surface  540 . The transverse leg  539  can have a first end that is attached to the anterior body portion  526 , and a second end that is offset from the first end along the posterior direction D po . The transverse leg  539  can be integral and monolithic with the anterior body portion  526 , although embodiments of the disclosure are not so limited. The second end can be a free end that is free from attachment to the anterior body portion  526  or any other portion of the osteotomy guide  500 . The transverse groove  516  can extend into the osteotomy guide  500  along the anterior direction D a . As such, a posterior end of the transverse groove  516  can be open, and an anterior end of the transverse groove  516  can be closed, where the posterior end is offset from the anterior end along the posterior direction D po . It will be understood that, in alternative embodiments, the transverse groove  516  can terminate adjacent to the first end or can be open at both the first and second ends. 
     The transverse leg  539  can have an edge  541  that can be used to verify correct positioning of the osteotomy guide  500 . The edge  541  can at least partially define a distal-most edge of the guide  500 . The edge  541  can extend along the transverse direction between the anterior end  606  and the posterior end  508 . The edge  541  can be configured to abut the bone when the osteotomy guide  500  is properly positioned along the bone. Proper positioning of the guide  500  can be verified by verifying that the edge  541  abuts the bone and no space exists between the edge  541  and the bone. 
     As can be seen in  FIGS. 20 and 21 , the bridge  537  separates the ascending groove  514  from the transverse groove  516 . As such, when the ascending cut and transverse cut are made in the bone, the bridge  537  can obstruct the cutting of the segment of the bone that joins the ascending cut and transverse cut and that underlies the bridge  537 . In this example, the bridge  537  obstructs the ascending cut. Thus, the first ascending guide surface  534 , and consequently the ascending cutting groove  514 , terminates such that it does not intersect the transverse cutting groove  516 . As such, the ascending cut may need to be extended after the osteotomy guide  500  is removed so as to join the ascending cut to the transverse cut. Extending the ascending cut may be easier than extending the transverse cut because the distance through which the ascending cut extends into the bone may be less than the distance into which the transverse cut extends into the bone. To accommodate such cutting, the first transverse guide surface  540  can extend at least up to, and in some embodiments beyond, the first ascending guide surface  534  with respect to the posterior direction D po . In other words, the first transverse guide surface  540  be intersected by a plane that is defined by the first ascending guide surface  534 . In embodiments that employ first and second transverse guide surfaces  538  and  540 , the plane that is defined by the first ascending guide surface  534  can intersect the transverse groove  516 . 
     The osteotomy guide  500  can define at least one fixation hole that extends through the osteotomy guide  500 . Each fixation hole can be configured to receive a fixation pin, such as a Kirschner wire, therethrough so as to affix the osteotomy guide  500  to the bone. Each fixation hole can extend through the inner surface  502  and the outer surface  504  of the osteotomy guide  500 . It will be understood that the locations of the fixation holes can vary from the embodiment shown. 
     In one example, the at least one fixation hole can include a proximal fixation hole  542 . The proximal fixation hole  542  can extend through the first arm  530  adjacent the proximal end  510  of the osteotomy guide  500 . The osteotomy guide  500  can include a neck  544  that extends from the anterior body portion  526  along the proximal direction D pr . The proximal fixation hole  542  can extend through the neck  544 . The proximal fixation hole  542  can correspond to a location of a hole of the bone fixation plate that is to be affixed to the bone. Thus, proximal fixation hole  542  can act as a guide for forming a hole in the bone that is used for both (i) a fixation pin that secures the osteotomy guide  500  to the bone and (ii) a bone anchor that affixes the bone fixation plate to the bone after the cut in the bone has been enlarged. 
     The at least one fixation hole can include at least one, such as two, distal bone fixation holes  546  and  548 . Each distal bone fixation hole  546  and  548  can be offset from the proximal bone fixation hole  542  with respect to the distal direction D d . Each distal bone fixation hole  546  and  548  can extend through the osteotomy guide  500  at a position adjacent to the first transverse guide surface  538  and transverse groove  516 . In some embodiments, each distal bone fixation hole  546  and  548  can be open at the first transverse guide surface  538 , such as open to the transverse groove  516 . In embodiments having first and second distal bone fixation holes  546  and  548 , the first distal bone fixation hole  546  can be spaced from the second distal bone fixation hole  548  along the anterior direction D a . The first and second distal bone fixation holes  546  and  548  can be aligned along a direction that is substantially parallel with the first transverse guide surface  538 . 
     The osteotomy guide  500  can be a unitary body having the first arm  530 , the second arm  532 , the ascending leg  535 , and the transverse leg  539 . In one example, the osteotomy guide  500  can be 3-D printed as a single monolithic body. Forming the osteotomy guide  500  as a single monolithic body can limit costs of 3-D printing the osteotomy guide  500  and can simplify the manufacturing process. In alternative embodiments, various components of the osteotomy guide  500  can be affixed, such as glued, welded, fastened, or otherwise coupled to, one another. Providing the osteotomy guide  500  as a unitary body can simplify handling of the osteotomy guide  500  and improve cutting accuracy over conventional guides that include two or more movable parts where stability of the movable parts can be difficult to maintain. 
     In one embodiment, a method of fabricating the osteotomy guide  500  can include obtaining a 3-D computer model of the patient&#39;s anatomy. This obtaining step can comprise receiving the 3-D computer model in a computer. Additionally, or alternatively, this obtaining step can comprise obtaining at least one image, such as a plurality of images, of the patient&#39;s anatomy using an imaging machine, such as a CT or MRI scan, and generating the 3-D computer model of the patient&#39;s anatomy from the image. The method can comprise a step of generating a 3-D computer model of the osteotomy guide  500  that conforms to the patient&#39;s anatomy. The method can comprise a step of 3-D printing the osteotomy guide  500  based on the 3-D computer model of the osteotomy guide  500 . 
     The osteotomy guide  500  can include one or more push positions that are configured to be pressed by a medical professional when positioning the guide  500  against the bone so as to properly align a position of the guide  500  on the bone. For example, the osteotomy guide  500  can include a first push position  531  that can be pressed by a medical professional when positioning the guide  500  against the bone so as to properly align a position of the guide  500  along the proximal and distal directions D pr  and D d . The second arm  532  can define the first push position  531 . The first push position  531  can be defined as a tab. The first push position  531  can include indicia that indicates the first push position  531 . For example, the first push position  531  can include ridges that extend out from the outer surface  504  of the guide  500 . In one such example, the ridges can include circular or oval ridges that are concentric. It will be understood that indicia other than ridges are contemplated, including indicia that does not protrude from the outer surface  504 . 
     Additionally, or alternatively, the osteotomy guide  500  can include a second push position  543  that can be pressed by a medical professional when positioning the guide  500  against the bone so as to properly align a position of the guide  500  along the anterior and posterior directions D a  and D p . The second push position  543  can be offset from the first push position  531  with respect to the distal direction D d . The second push position  543  can be offset from the first push position  531  with respect to the anterior direction D a . The second push position  543  can be offset from the first push position  531  with respect to the outward direction D o . The second push position  543  can be defined as a tab. The second push position  543  can include indicia that indicates the second push position  543 . For example, the second push position  543  can include ridges that extend out from the outer surface  504  of the guide  500 . In one such example, the ridges can include circular or oval ridges that are concentric. It will be understood that indicia other than ridges are contemplated, including indicia that does not protrude from the outer surface  504 . 
     A surgical method that employs the osteotomy guide  500  of  FIGS. 16 to 24  can be implemented in a manner similar to that of the method of  FIGS. 9 to 14 , with a few notable differences. In the alignment step  404 , the medical professional can press at least one of (i) the first push position  531  so as to properly position the guide  500  along the proximal and distal directions D pr  and D d , and (ii) the second push position  543  so as to properly position the guide  500  along the anterior and posterior directions D a  and D po . In the verifying step  408 , the medical professional can verify that the edges  533  and  541  abut and conform to the bone such that no spaces exist between the edge  533  and the bone or between the edge  541  and the bone. The enlarging step  416  can comprise using a cutting instrument, such as a chisel or saw, to further enlarge the ascending portion of the cut, rather than the transverse portion, thereby extending the ascending portion of the cut to the transverse portion of the cut. 
     Turning now to  FIGS. 25 to 34 , an osteotomy guide  600  is shown according to another embodiment. The osteotomy guide  600  is configured to guide at least one cutting instrument to make a cut into a bone for an osteotomy procedure. The osteotomy guide  600  can be custom constructed to conform to a bone of a specific patient. In other words, the osteotomy guide  600  may be patient specific. The osteotomy guide  600  can be three-dimensionally (3-D) printed or can be fabricated in any other suitable manner. In at least some embodiments, the osteotomy guide  600  can include a one-piece body. The osteotomy guide  600  defines at least one ascending guide surface  634  and at least one transverse guide surface  638  (both labeled in  FIGS. 29 and 30 ) that are configured to guide at least one cutting instrument, such as a saw blade, to make a cut into a bone such as a tibia, femur, fibula, humerus, ulna, radius, or other bone. The osteotomy guide  600  can be configured to guide a cut into the bone adjacent to a joint, the cut dividing the bone into first and second bone segments, the first bone segment being closer to the joint. The cut can then be enlarged by pivoting the first segment of the patient&#39;s bone relative to the second segment of the bone so as to realign the bone. For example, the cut can be enlarged to realign the weight bearing line, to balance the pressure in the knee, although other alignment procedures are contemplated. The enlarged cut can then be fixed by attaching a bone plate that extends across the cut from the first bone segment to the second bone segment so as to affix the bone on opposed sides of the enlarged cut. For illustrative purposes, the guide  600  will be described and shown relative to its use in making a cut in a tibia. 
     Referring more specifically to  FIGS. 25 to 28 , the osteotomy guide  600  has an inner surface  602 , and an outer surface  604  opposite the inner surface  602  with respect to an outward direction D o . In other words, the inner surface  602  is opposite from the outer surface  604  with respect to an inward direction D i , where the inward direction D i  is opposite the outward direction D o . The inner surface  602  can be a bone facing surface configured to face the bone. At least a portion of the inner surface  602  is configured to contact the bone, and thus, can be considered to be a bone contacting surface. Thus, the inner surface  602  can have at least one bone contacting region  618  that is contoured so as to conform to a surface of the bone. The contour can be generally concave or can be any suitable contour to match the surface of the bone. In alternative embodiments (not shown), the inner surface  602  can have at least two bone contacting regions in a manner similar to that described above with respect to  FIGS. 1 to 15  and  FIGS. 16 to 24 . The outer surface  604  can be configured to face away from the bone. In some examples, the outer surface  604  can be substantially convex, although embodiments of the disclosure are not so limited. 
     The osteotomy guide  600  has an anterior end  606 , and a posterior end  608  opposite the anterior end  606  with respect to a posterior direction D po . In other words, the anterior end  606  is opposite the posterior end  608  with respect to an anterior direction D a , where the anterior direction D a  and posterior direction D po  are opposite one another. Note that, as used herein, the anterior and posterior directions D a  and D po  together may also be referred to as a transverse direction. The osteotomy guide  600  can be configured to be positioned on the bone such that the anterior end  606  is adjacent an anterior side of the bone and the posterior end  608  is adjacent a posterior side of the bone. However, it will be understood that osteotomy guide  600  can be otherwise positioned. The anterior direction D a  and the posterior direction D po  can be perpendicular to both the inward and outward directions D in  and D o . 
     The osteotomy guide  600  has a proximal end  610 , and a distal end  612  opposite the proximal end  610  with respect to a distal direction D d . In other words, the proximal end  610  is opposite the distal end  612  with respect to a proximal direction D pr , where the proximal direction D pr  and distal direction D a  are opposite one another. The osteotomy guide  600  can include a proximal body portion  626 , and a distal body portion  628  that is offset from the proximal body portion  626  along the distal direction D a . The distal body portion  628  can include the at least one bone contacting region  618  of the inner surface  602 . The osteotomy guide  600  is configured to be positioned on the bone such that the proximal end  610  is oriented towards a proximal end of the bone, and the posterior end  612  is oriented towards a distal end the bone. The proximal direction D pr  and distal direction D a  can be perpendicular to the inward direction D in , the outward direction D o , the anterior direction D a , and the posterior direction D po . 
     With reference to  FIGS. 29 and 30 , the osteotomy guide  600  can have at least one ascending guide surface that is configured to guide the cutting instrument along an ascending cutting path to make an ascending cut into the bone. However, it will be understood that, in alternative embodiments, the guide  100  can be devoid of an ascending guide surface. The ascending cut may be made, for example, around the tibial tuberosity behind the patellar tendon. Thus, the osteotomy guide  600  can be configured (e.g., sized and shaped) such that each of the at least one ascending guide surface is aligned with the tibial tuberosity when the osteotomy guide  600  is affixed to the bone. Each of the at least one ascending guide surface can be disposed at the anterior end  606  of the osteotomy guide  600 . The at least one ascending guide surface can include a first ascending guide surface  634 . The first ascending guide surface  634  can extend along an ascending direction that is angularly offset with respect to the proximal direction D pr  and the transverse direction (e.g., the anterior and posterior directions D a  and D po ). For example, the ascending direction can extend at an angle that is between the proximal direction D pr  and the transverse direction. Thus, the first ascending guide surface  634  can be angled towards the anterior direction D a  as the first ascending guide surface  634  extends towards the proximal end  610 . The distal body portion  628  can define the first ascending guide surface  634 . In alternative embodiments (not shown), the at least one ascending guide surface can include a second ascending guide surface that is offset from the first ascending guide surface  634  so as to define an ascending groove therebetween in a manner similar to that described above. 
     The osteotomy guide  600  can have at least one transverse guide surface that is configured to guide a cutting instrument along a transverse cutting path to make a transverse cut into the bone. Each transverse guide surface can be disposed at the distal end  612  of the osteotomy guide  600 . The at least one transverse guide surface can include a first transverse guide surface  638 . The first transverse guide surface  638  can extend along the anterior direction D a  and the posterior direction D po  (herein, collectively referred to as the transverse direction) so as to at least partially define a transverse cutting path into the bone. At least one of the ascending and transverse cutting paths can intersect the other. The distal body portion  628  can define the first transverse guide surface  638 . In alternative embodiments (not shown), the at least one transverse guide surface can include a second transverse guide surface that is offset from the first transverse guide surface  638  so as to define a transverse groove therebetween in a manner similar to that discussed above. 
     The osteotomy guide  600  can define at least one fixation hole that extends through the osteotomy guide  600 . Each fixation hole can be configured to receive a fixation pin, such as a Kirschner wire, therethrough so as to affix the osteotomy guide  600  to the bone. Each fixation hole can extend through the inner surface  602  and the outer surface  604  of the osteotomy guide  600 . It will be understood that the locations of the fixation holes can vary from the embodiment shown. 
     In one example, the at least one fixation hole can include a proximal fixation hole  642 . The osteotomy guide  600 , such as the proximal body portion  626 , can include a neck  644  that extends from the distal body portion  628  along the proximal direction D pr . The proximal fixation hole  642  can extend through the neck  644 . The neck  644  can have an inner surface  645  that is configured to face the bone. The inner surface  645  of the neck  644  can be offset with respect to the at least one bone contacting surface  618  with respect to the outward direction D O . Consequently, when the bone facing surface  618  is aligned with the bone, the inner surface  645  of the neck  644  can be spaced from the bone so as to accommodate soft tissue between the inner surface  645  and the bone. Further, the proximal fixation hole  642  can correspond to a location of a hole of the bone fixation plate that is to be affixed to the bone. Thus, proximal fixation hole  642  can act as a guide for forming a hole in the bone that is used for both (i) a fixation pin that secures the osteotomy guide  600  to the bone and (ii) a bone anchor that affixes the bone fixation plate to the bone after the cut in the bone has been enlarged. 
     The at least one fixation hole can include at least one, such as two, distal bone fixation holes  646  and  648 . Each distal bone fixation hole  646  and  648  can be offset from the proximal bone fixation hole  642  with respect to the distal direction D d . Each distal bone fixation hole  646  and  648  can extend through the osteotomy guide  600 , such as through the distal body portion  628 . In embodiments having first and second distal bone fixation holes  646  and  648 , the first distal bone fixation hole  646  can be spaced from the second distal bone fixation hole  648  along the anterior direction D a . The first and second distal bone fixation holes  646  and  648  can be aligned along a direction that is substantially parallel with the first transverse guide surface  638 . 
     With reference to  FIGS. 29, 30, 33, and 34 , the osteotomy guide  600  can include an alignment guide  650  that is configured to aid in re-alignment of the first and second bone segments (e.g.,  300   a  and  300   b  in  FIG. 34 ) once the cut divides the bone into first and second bone segments. For example, the alignment guide  650  can include an arm that extends away from the distal body portion  628  along the distal direction D d , although the alignment guide  650  can be configured in a manner other than an arm. The alignment guide  650  can extend from the distal body portion  628  adjacent the anterior end  606  of the guide  600 . The alignment guide  650  can be offset from the inner surface  602  with respect to the outward direction D o  such that a cutting instrument can be inserted between the alignment guide  650  and the bone so as to cut the bone at a position that underlies the alignment guide  650  while the osteotomy guide  600  is attached to the bone, thereby allowing the transverse and ascending cuts to be joined without removing the osteotomy guide  600 . 
     The alignment guide  650  can define an opening  654  therethrough that extends along the inner and outer directions D i  and D o . The opening  654  can be configured to receive an alignment member  212 , such as a Kirshner wire, a shaft, a bar, or any other suitable member. The alignment guide  650  is configured such that, when the osteotomy guide  600  is attached to the first bone segment  300   a  and the alignment member  212  is received in the opening  654 , the alignment member  212  abuts an inner surface of the second bone segment  300   b  when the first bone segment  300   a  is moved to affect the desired realignment of the bone. The inner surface of the second bone segment  300   b  can be the surface of the second bone segment  300   b  that is formed by the transverse cut  310 . Desired alignment of the first bone segment  300   a  can be determined by moving the first bone segment  300   a  so as to enlarge the osteotomy cut  307  until the alignment member  212  abuts the inner surface of the second bone segment  300   b . It will be understood that, although not shown, the embodiments of  FIGS. 1 to 24  can have an alignment guide configured in the same manner as the alignment guide  650 . 
     The osteotomy guide  600  can be a unitary body having the proximal body portion  626 , the distal body portion  628 , and the alignment guide  650 . In one example, the osteotomy guide  600  can be 3-D printed as a single monolithic body. Forming the osteotomy guide  600  as a single monolithic body can limit costs of 3-D printing the osteotomy guide  600  and can simplify the manufacturing process. In alternative embodiments, various components of the osteotomy guide  600  can be affixed, such as glued, welded, fastened, or otherwise coupled to, one another. Providing the osteotomy guide  600  as a unitary body can simplify handling of the osteotomy guide  600  and improve cutting accuracy over conventional guides that include two or more movable parts where stability of the movable parts can be difficult to maintain. 
     In one embodiment, a method of fabricating the osteotomy guide  600  can include obtaining a 3-D computer model of the patient&#39;s anatomy. This obtaining step can comprise receiving the 3-D computer model in a computer. Additionally, or alternatively, this obtaining step can comprise obtaining an image of the patient&#39;s anatomy using an imaging machine, and generating the 3-D computer model of the patient&#39;s anatomy from the image. The method can comprise a step of generating a 3-D computer model of the osteotomy guide  600  that conforms to the patient&#39;s anatomy. The method can comprise a step of 3-D printing the osteotomy guide  600  based on the 3-D computer model of the osteotomy guide  600 . 
     A surgical method that employs the osteotomy guide  600  of  FIGS. 25 to 34  can be implemented in a manner similar to that of the method of  FIGS. 9 to 14 , with a few notable differences. In the cutting steps  410  and  412 , the cutting instrument can be passed under the alignment guide  650  so as to cut into the bone to join the ascending and transverse cuts. The step  414  of removing the osteotomy guide can be omitted, and the enlarging step  416  can be performed with the osteotomy guide  600  attached to the bone  300 . In so doing, a distractor instrument (not shown) can be used to enlarge the cut  307  in step  416  until the alignment member  212  abuts the inner surface of the second bone segment  300   b . After enlarging the cut  307 , the distractor instrument can maintain the first and second bone segments  300   a  and  300   b  in the desired relative positions while the osteotomy guide  600  is removed, and the plate is affixed in step  418 . 
     Turning now to  FIGS. 35 to 41 , a spacer  700  is shown according to one embodiment. At least a portion of the spacer  700  is configured to be received in the osteotomy cut  307  in the bone between the first bone segment  300   a  and the second bone segment  300   b  so as to provide a desired spacing between the first and second bone segments  300   a  and  300   b . The spacer  700  can be inserted into the osteotomy cut  307  after the transverse cut  310  and ascending cut  308  has been made (e.g., in step  416  of  FIG. 9  above). The spacer  700  has a first end  702  and a second end  704  that are opposite one another along a first direction D 1 . The spacer  700  can have a handle portion  706  and a wedge portion  708 . The handle portion  706  can extend from the first end  702  towards the second end  704 , such as to the wedge portion  708 . The handle portion  706  can have any suitable shape for grasping by a medical professional. For example, the handle portion  706  can have a substantially cylindrical shape. 
     The wedge portion  708  can extend from the second end  704  towards the first end  702 , such as to the handle portion  706 . The wedge portion  708  can have a first bone facing surface  710  and a second bone facing surface  712  that are opposite one another with respect to a second direction D 2 , perpendicular to the first direction D 1 . The first and second bone facing surfaces  710  and  712  can taper towards one another as they extend in the first direction D 1  towards the second end  704 . The first and second bone facing surfaces  712  can be configured to engage opposing surfaces of the first and second bone segments  300   a  and  300   b  so as to space the first and second bone segments  300   a  and  300   b  from one another. 
     The wedge portion  708  can have a first side  714  and a second side  716  that are opposite from one another along a third direction D 3 . The first and second sides  714  and  716  can extend between the first and second bone facing surfaces  710  and  712 . The second side  716  can taper towards the first side  714  as the second side  716  extends along the first direction D 1  towards the first end  702 . In one example, the second side  716  can curve towards the first side  714  as the second side  716  extends along the first direction D 1  towards the first end  702 . The curvature of the second side  716  can conform to a curvature of the bone when the wedge portion  708  is seated in the cut  307  in the bone  300 . The first side  714  can be substantially planar or can have any other suitable shape. 
     The spacer  700  can include at least one stop that is configured to limit an insertion depth of the spacer  700  into the bone  300 . For example, the spacer  700  can include a first stop  718  that is configured to limit translation of the spacer  700  into the bone  300  along the first direction D 1 . The first stop  718  can be supported at a proximal end of the wedge portion  708 . The first stop  718  can have a width along the second direction D 2  that is greater than a width of the wedge portion  708  along the second direction D 2 . The first stop  718  can extend outwardly relative to at least one, such as both, of the first and second bone facing surfaces  710  and  712  with respect to the second direction D 2 . The first stop  718  can define at least one shoulder  720 , such as a pair of shoulders  720 , each shoulder  720  configured to rest on the bone  300  when the spacer  700  is received in the cut  307  as shown in  FIG. 40 . Each shoulder  720  can face in a direction (e.g., the first direction D 1 ) that extends towards the second end  704 . The first side  714  and/or first stop  718  can be configured such that the bone fixation plate  250  abuts the first stop  718  as shown in  FIG. 41  when the first stop  718  is received in the cut  307  so as to properly align the bone fixation plate  250  along the bone  300 . 
     Additionally, or alternatively, the spacer  700  can include a second stop  722  that is configured to limit rotation of the spacer  700  relative to the bone  300  along an axis that extends along the second direction D 2 . The second stop  722  can be supported by the wedge portion  708 . For example, the second stop  722  can be supported along the second side  716  between the handle  706  and the second end  704  of the spacer  700 . The second stop  722  can project outwardly from the second side  716  with respect to the third direction D 3 . The second stop  722  can have a width along the second direction D 2  that is greater than a width of the wedge portion  708  along the second direction D 2 . The second stop  722  can extend outwardly relative to at least one, such as both, of the first and second bone facing surfaces  710  and  712  with respect to the second direction D 2 . The second stop  722  can define at least one shoulder  724 , such as a pair of shoulders  724 , each shoulder  724  configured to rest on the bone  300  when the spacer  700  is received in the cut  307  as shown in  FIGS. 40 and 41 . Each shoulder  724  can face in a direction (e.g., the second direction D 2 ) that extends towards the first side  714 . The spacer  700  is configured such that, when the second stop  722  abuts the bone  300 , the stop  722  restricts rotation of the spacer  700  into the cut  706  about an axis that extends along the second direction D 2 . 
     Turning now to  FIGS. 42 to 49 , a spacer  800  is shown according to another embodiment. At least a portion of the spacer  800  is configured to be received in the cut  307  in the bone between the first bone segment  300   a  and the second bone segment  300   b  so as to provide a desired spacing between the first and second bone segments  300   a  and  300   b . The spacer  800  can be inserted into the osteotomy cut  307  after the transverse cut  310  and ascending cut  308  has been made (e.g., in step  416  of  FIG. 9  above). The spacer  800  has a first end  802  and a second end  804  that are opposite one another along a first direction D 1 . The spacer  800  has a first wedge portion  806  and a second wedge portion  808  that are offset from one another along a second direction D 2 , perpendicular to the first direction D 1 . In at least some embodiments, the first wedge portion  806  can be spaced from the second wedge portion  808  so as to define a space between the first and second wedge portions  806  and  808  along the second direction D 2 . The spacer  800  can have a connector  810  that connects the first and second wedge portions  806  and  808  to one another. 
     The first wedge portion  806  can extend from the first end  802  to the second end  804 . The first wedge portion  806  can have an upper surface  812  and a lower surface  814  that are opposite one another along a third direction D 3 , perpendicular to the first and second directions D 1  and D 2 . At least one of the upper surface  812  and the lower surface  814  can taper towards the other as it extends towards the second end  804 . The first wedge portion  806  can include an outer surface  816 . In embodiments in which the first wedge portion  806  is spaced from the second wedge portion  808 , the first wedge portion  806  can include an inner surface  818  that is opposite the outer surface  816  along the second direction D 2 . 
     The second wedge portion  808  can extend from the first end  802  to the second end  804 . The second wedge portion  808  can have an upper surface  824  and a lower surface  826  that are opposite one another along the third direction D 3 , perpendicular to the first and second directions D 1  and D 2 . At least one of the upper surface  824  and the lower surface  826  can taper towards the other as it extends towards the second end  804 . The second wedge portion  808  can include an outer surface  820 . In embodiments in which the second wedge portion  808  is spaced from the first wedge portion  806 , the second wedge portion  808  can include an inner surface  822  that is opposite the outer surface  820  along the second direction D 2 . 
     The spacer  800  can include at least one stop that is configured to limit an insertion depth of the spacer  800  into the bone  300 . For example, at least one of the first wedge portion  806  and the second wedge portion  808  can include such a stop (e.g.,  812   a ,  814   a ,  824   a ,  826   a ). In some examples, each of the first and second wedge portions  806  and  808  can include such a stop. In some examples, at least one of the first and second wedge portions  806  and  808  can include a plurality, such as a pair, of such stops. In some examples, the spacer  800  can have at least one stop (e.g.,  812   a ,  824   a ) that is configured to abut the first bone segment  300   a  and at least one stop (e.g.,  814   a ,  826   a ) that is configured to abut the second bone segment  300   b .  FIGS. 42 to 49  show an embodiment that has four stops, however, it will be understood that the spacer  800  can have as few as one of the stops or any combination of two or more of the stops. 
     At least one of the upper surface  812  and the lower surface  814  of the first wedge portion  806  can include a stop that is configured to limit an insertion depth of the spacer  800  into the bone  300 . For example, the upper surface  812  can include a stop  812   a  that is configured to limit translation of the spacer  800  into the bone  300  along the first direction D 1 . The upper surface  812  can include a bone contacting region  812   b  and a non-bone contacting region  812   c . The bone contacting region  812   b  can be between the non-bone-contacting region  812   c  and the second end  804 . The non-bone-contacting region  812   c  can be between the first end  802  and the bone contacting region  812   b . The bone contacting region  812   b  can be inwardly offset from the non-bone-contacting region  812   c  with respect to the third direction D 3 . The stop  812   a  can extend from the bone contacting region  812   b  to the non-bone-contacting region  812   c  so as to define a shoulder that is configured to abut one of the first and second bone segments  300   a  and  300   b  of the bone  300  when the spacer  800  is received in the osteotomy cut  307  in the bone  300 . The stop  812   a  can extend between the outer surface  816  and the inner surface  818 . The stop  812   a  be contoured (e.g., curved or angled) as it extends along the second direction D 2  between the outer surface  816  and the inner surface  818  so as to conform to the one of the first and second bone segments  300   a  and  300   b.    
     Additionally, or alternatively, the lower surface  814  of the first wedge portion  806  can include a stop  814   a  that is configured to limit translation of the spacer  800  into the bone  300  along the first direction D 1 . For example, the lower surface  814  can include a stop  814   a  that is configured to limit translation of the spacer  800  into the bone  300  along the first direction D 1 . The lower surface  814  can include a bone contacting region  814   b  and a non-bone-contacting region  814   c . The bone contacting region  814   b  can be between the non-bone-contacting region  814   c  and the second end  804 . The non-bone-contacting region  814   c  can be between the first end  802  and the bone contacting region  814   b . The bone contacting region  814   b  can be inwardly offset from the non-bone contacting region  814   c  with respect to the third direction D 3 . The stop  814   a  can extend from the bone contacting region  814   b  to the non-bone-contacting region  814   c  so as to define a shoulder that is configured to abut another one of the first and second bone segments  300   a  and  300   b  of the bone  300  when the spacer  800  is received in the osteotomy cut  307  in the bone  300 . The stop  814   a  can extend between the outer surface  816  and the inner surface  818 . The stop  814   a  be contoured (e.g., curved or angled) as it extends along the second direction D 2  between the outer surface  816  and the inner surface  818  so as to conform to the other one of the first and second bone segments  300   a  and  300   b.    
     Additionally, or alternatively, the upper surface  824  of the second wedge portion  808  can include a stop  824   a  that is configured to limit translation of the spacer  800  into the bone  300  along the first direction D 1 . The upper surface  824   a  can include a bone contacting region  824   b  and a non-bone-contacting region  824   c . The bone contacting region  824   b  can be between the non-bone-contacting region  824   c  and the second end  804 . The non-bone-contacting region  824   c  can be between the first end  802  and the bone contacting region  824   b . The bone contacting region  824   b  can be inwardly offset from the non-bone-contacting region  824   c  with respect to the third direction D 3 . The stop  824   a  can extend from the bone contacting region  824   b  to the non-bone-contacting region  824   c  so as to define a shoulder that is configured to abut the one of the first and second bone segments  300   a  and  300   b  of the bone  300  when the spacer  800  is received in the osteotomy cut  307  in the bone  300 . The stop  824   a  can extend between the outer surface  820  and the inner surface  822 . The stop  824   a  be contoured (e.g., curved or angled) as it extends along the second direction D 2  between the outer surface  820  and the inner surface  822  so as to conform to the one of the first and second bone segments  300   a  and  300   b.    
     Additionally, or alternatively, the lower surface  826  of the second wedge portion  808  can include a stop  826   a  that is configured to limit translation of the spacer  800  into the bone  300  along the first direction D 1 . For example, the lower surface  826  can include a stop  826   a  that is configured to limit translation of the spacer  800  into the bone  300  along the first direction D 1 . The lower surface  826  can include a bone contacting region  826   b  and a non-bone-contacting region  826   c . The bone contacting region  826   b  can be between the non-bone-contacting region  826   c  and the second end  804 . The non-bone-contacting region  826   c  can be between the first end  802  and the bone contacting region  826   b . The bone contacting region  826   b  can be inwardly offset from the non-bone-contacting region  826   c  with respect to the third direction D 3 . The stop  826   a  can extend from the bone contacting region  826   b  to the non-bone-contacting region  826   c  so as to define a shoulder that is configured to abut the other one of the first and second bone segments  300   a  and  300   b  of the bone  300  when the spacer  800  is received in the osteotomy cut  307  in the bone  300 . The stop  826   a  can extend between the outer surface  820  and the inner surface  822 . The stop  826   a  be contoured (e.g., curved or angled) as it extends along the second direction D 2  between the outer surface  820  and the inner surface  822  so as to conform to the other one of the first and second bone segments  300   a  and  300   b.    
     The first wedge portion  806  can have a first height H 1  from the bone contacting region  812   b  of the upper surface  812  to the bone contacting region  814   b  of the lower surface  814  along the third direction D 3 . Similarly, the second wedge portion  808  can have a second height H 2  from the bone contacting region  824   b  of the upper surface  824  to the bone contacting region  826   b  of the lower surface  826  along the third direction D 3 . In one embodiment, the first height H 1  can be different from the second height Hz. For example, the first height H 1  can be equal to the second height Hz such that the first and second wedge portions  806  and  808  provide the same spacing within the osteotomy cut  307 . In such a case, the spacer  800  can be configured to correct a deformity in the frontal plane (i.e., planar adjustment of the first bone segment  300   a ). In another example, the first height H 1  can be less than or greater than the second height H 2  to provide different spacing within the osteotomy cut  307 . In such a case, the spacer  800  can be configured to correct a deformity in both the frontal plane and the sagittal plane (i.e., bi-planar adjustment of the first bone segment  300   a ). 
     The connector  810  can extend from the first wedge portion  806  to the second wedge portion  808  along the second direction D 2 . The connector  810  can be supported by the first and second wedge portions  806  and  808  adjacent the first end  802 . The connector  810  can be offset from each of the at least one stop towards the first end  802  with respect to the first direction D 1  such that a space  828  is defined between the at least one stop and the connector  810 . As shown in  FIGS. 48 and 49 , the space  828  can be sized to receive the bone fixation plate  250  between the connector  810  and the bone  300  when the at least one stop abuts the bone  300 . 
     While certain example embodiments have been described, these embodiments have been presented by way of example only and are not intended to limit the scope of the inventions disclosed herein. Thus, nothing in the foregoing description is intended to imply that any particular feature, characteristic, step, module, or block is necessary or indispensable. Indeed, the novel methods and systems described herein may be embodied in a variety of other forms; furthermore, various omissions, substitutions, and changes in the form of the methods and systems described herein may be made without departing from the spirit of the inventions disclosed herein. The accompanying claims and their equivalents are intended to cover such forms or modifications as would fall within the scope and spirit of certain of the inventions disclosed herein. 
     Conditional language used herein, such as, among others, “can,” “could,” “might,” “may,” “e.g.,” and the like, unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain embodiments include, while other embodiments do not include, certain features, elements, and/or steps. Thus, such conditional language is not generally intended to imply that features, elements, and/or steps are in any way required for one or more embodiments or that one or more embodiments necessarily include logic for deciding, with or without author input or prompting, whether these features, elements and/or steps are included or are to be performed in any particular embodiment. The terms “comprising,” “including,” “having,” and the like are synonymous and are used inclusively, in an open-ended fashion, and do not exclude additional elements, features, acts, operations, and so forth. Also, the term “or” is used in its inclusive sense (and not in its exclusive sense) so that when used, for example, to connect a list of elements, the term “or” means one, some, or all of the elements in the list.