Patent Publication Number: US-2023149045-A1

Title: Bone repositioning guide system and procedure

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This claims priority to U.S. Patent Application Ser. No. 63/263,076 filed Oct. 26, 2021, and is a continuation-in-part of U.S. patent application Ser. No. 17/938,289 filed Oct. 5, 2022, which is a continuation-in-part of U.S. patent application Ser. No. 17/305,644 filed Jul. 12, 2021, which is a divisional of U.S. patent application Ser. No. 16/938,375 filed Jul. 24, 2020 (issued as U.S. Pat. No. 11,058,546), which claims priority to U.S. Patent Application Ser. No. 62/879,340 filed Jul. 26, 2019, the disclosure of each of which is hereby incorporated by reference as if set forth in its entirety herein. 
    
    
     FIELD 
     The present invention generally relates to surgical systems and procedures for correcting alignment between two bones or bone segments spanning a joint or an osteotomy, and particularly relates to surgical systems and procedures for correcting a bunion in a patient&#39;s foot. 
     BACKGROUND 
     Bone misalignment and/or deformation can be a source of discomfort and reduced mobility in patients, particularly in a patient&#39;s feet. One particularly common foot disorder is a bunion. Bunions are a progressive disorder, typically beginning with a leaning of the great toe. The leaning of the great toe may gradually change an angle of the bones and produce a characteristic bump on the medial side of the metatarsal near the joint of the metatarsal with the proximal phalanx. Specifically, the bunion is the prominence made of bone and at times an inflamed bursa. Hallux valgus is the condition in which the great toe deviates from the normal position toward the direction of the second toe. Accordingly, the present invention is directed to surgical systems and procedures for correction of bunions, Hallux valgus, and for bone realignments more generally. 
     SUMMARY 
     The foregoing summary is illustrative only and is not intended to be limiting. Other aspects, features, and advantages of the systems, devices, and methods and/or other subject matter described in this application will become apparent in the teachings set forth below. The summary is provided to introduce a selection of some of the concepts of this disclosure. The summary is not intended to identify key or essential features of any subject matter described herein. 
     According to one aspect of the disclosure, a method for correcting alignment between a first bone and a second bone by fusing a joint between the first bone and the second bone includes providing a first guide. The first guide includes a first end portion with a first cannula aligned along a first axis. A second end portion has a second cannula aligned along a second axis. The first axis is non-parallel with the second axis. The first axis is configured to intersect the first bone and the second axis is configured to intersect the second bone when the first and second bones are in a deformed configuration. A first k-wire is inserted through the first cannula and into the first bone. A second k-wire is inserted through the second cannula and into the second bone. The first guide is removed from the first and second k-wires. A second guide includes a first end portion with a first cannula. A second end portion has a second cannula. The first cannula is parallel with the second cannula. The second guide slides over the first and second k-wires. The first k-wire is received within the first cannula of the second guide and the second k-wire is received within the second cannula of the second guide. The second guide acts on the first and second k-wires to re-align the first and second bones into a corrected configuration. 
     In another aspect, the method includes fixing the first and second bones in the corrected configuration and removing the second guide and the first and second k-wires from the first and second bones. 
     In another aspect, the method includes fixing the first and second bones in the corrected configuration includes inserting a first stabilizing wire into the first and second bones. 
     In another aspect, the method includes attaching a first end of a bone plate with the first bone and a second end of the bone plate with the second bone such that the first and second bones are retained in the corrected configuration. 
     In another aspect, the method includes inserting a bone plate clip into the first and second bones. 
     In another aspect, the method includes resecting a first end of the first bone. 
     In another aspect, the first end portion of the first guide includes a third cannula aligned parallel with the first axis. 
     In another aspect, the method includes inserting a third k-wire into the first bone through the third cannula and resecting the first end of the first bone includes inserting a first resecting guide over the first and third k-wires to align the first resecting guide with the first end of the first bone. 
     In another aspect, the method includes resecting a first end of the second bone. 
     In another aspect, the second end of the first guide includes a fourth cannula aligned parallel with the second axis. 
     In another aspect, the method includes resecting the first end of the second bone. 
     In another aspect, the method includes inserting a second resecting guide over the second k-wire and a fourth k-wire inserted in the second bone to align the second resecting guide with the first end of the second bone. 
     In another aspect, the first bone is a metatarsal, the second bone is a medial cuneiform bone, the deformed configuration of the first and second bones includes a bunion and the corrected configuration of the first and second bones corrects the bunion. 
     In another aspect, the second guide adjusts an angle of the first bone in three orthogonal planes between the deformed configuration and the corrected configuration. 
     In another aspect, the second guide adjusts a position of the first bone in three orthogonal planes between the deformed configuration and the corrected configuration. 
     In another aspect, the method includes centering the first guide between the first bone and the second bone by inserting a centering k-wire through a centering cannula on the first guide. 
     In another aspect, the method includes removing the first guide from the first and second k-wires includes at least partially disassembling the first guide. 
     In another aspect, the method includes scanning the first bone and the second bone in the deformed configuration to render a 3D model thereof including a first virtual bone and a second virtual bone in a virtual deformed configuration, adjusting the first virtual bone and the second virtual bone in the 3D model to align the first virtual bone and the second virtual bone in a virtual corrected configuration, fixing a first virtual axis relative to the first virtual bone and fixing a second virtual axis relative to the second virtual bone in the virtual corrected configuration, the first virtual axis is parallel with the second virtual axis, and returning the first and second virtual bones to the virtual deformed configuration, the first and second virtual axes defining a correction factor therebetween in the virtual deformed configuration. 
     In another aspect, the method includes identifying a virtual resection plane where the first virtual bone and the second virtual bone overlap in the virtual corrected configuration, and fixing the first virtual axis relative to the first virtual bone includes aligning the first virtual axis parallel with the virtual resection plane. 
     In another aspect, the method includes forming the first guide based on the correction factor. 
     In another aspect, the correction factor includes a first virtual vector passing through a first virtual point in a virtual coordinate plane and a second virtual vector passing through a second virtual point in the virtual coordinate plane. 
     In another aspect, forming the first guide includes correlating the virtual coordinate plane with a coordinate plane of the first guide such that the first axis corresponds with the first virtual vector and the first virtual point and the second axis aligned corresponds with the second virtual vector and the second virtual point. 
     In another aspect, each of the correction factors includes a position vector and two direction vectors corresponding to the first and second axis of the respective guides within the plurality of guides. 
     In another aspect, the first guide is selected from a plurality of guides, each of the plurality of guides has a different angle between the first and second axes. 
     According to another aspect, a method of manufacturing a kit for correcting alignment between a first bone and a second bone includes receiving a correction factor, the correction factor including a first virtual vector passing through a first virtual point in a virtual coordinate plane and a second virtual vector passing through a second virtual point in the virtual coordinate plane. 
     A first guide is formed based on the correction factor, the first guide including a first end portion having a first cannula aligned along a first axis and a second end portion having a second cannula aligned along a second axis. The first axis corresponds to the first virtual vector and the first virtual point and the second axis corresponds to the second virtual vector and the second virtual point, the first and second axes is non-parallel. The first guide is configured such that a first k-wire inserted through the first cannula intersects the first bone and a second k-wire inserted through the second cannula intersects the second bone in a deformed configuration. 
     In another aspect, the method includes receiving dimensions of a second guide, the second guide including a first end portion with a first cannula and a second end portion with a second cannula. The first cannula is parallel with the second cannula. The first guide is configured such that when sliding the second guide over the first and second k-wires, the first and second k-wires are received within the respective first and second cannula of the second guide and the second guide re-aligns the first and second bones into a corrected configuration. 
     In another aspect, the method includes receiving a scan of the first bone and the second bone in the deformed configuration to render a 3D model thereof including a first virtual bone and a second virtual bone in a virtual deformed configuration. The first virtual bone and the second virtual bone are adjusted in the 3D model to align the first virtual bone and the second virtual bone in a virtual corrected configuration. A first virtual axis is fixed relative to the first virtual bone and a second virtual axis is fixed relative to the second virtual bone in the virtual corrected configuration. The first virtual axis is parallel with the second virtual axis. The first and second virtual bones are returned to the virtual deformed configuration along with the first and second virtual axes defining the first and second virtual vectors and the first and second virtual points, respectively, of the correction factor. 
     In another aspect, the method includes identifying a virtual resection plane where the first virtual bone and the second virtual bone overlap in the virtual corrected configuration and fixing the first virtual axis relative to the first virtual bone includes aligning the first virtual axis parallel with the virtual resection plane. 
     According to another aspect of the disclosure, a kit for correcting alignment between a first bone and a second bone by fusing a joint between the first bone and the second bone includes a first guide. The first guide includes a first end portion with a first cannula aligned along a first axis and a second end portion with a second cannula aligned along a second axis. The first axis is non-parallel with the second axis. The first guide is configured such that inserting a first k-wire through the first cannula intersects the first bone and inserting a second k-wire through the second cannula intersects the second bone when the first and second bones are in a deformed configuration. A second guide includes a first end portion with a first cannula and a second end portion with a second cannula. The first cannula can be parallel with the second cannula. The second guide is configured such that when the first k-wire is fixed within the first bone and the second k-wire is fixed within the second bone in the deformed configuration, sliding the second guide over first and second k-wires, with the first and second k-wires is received within the respective first and second cannula of the second guide, re-aligns the first and second bones into a corrected configuration. 
     In another aspect, a stabilizing wire fixes the first and second bones in the corrected configuration by insertion into the first and second bones. 
     In another aspect, a bone plate with a first end configure[d to be attached with the first bone and a second end of the bone plate configured to be attached with the second bone retains the first and second bones in the corrected configuration. 
     In another aspect, a bone plate clip inserts into the first and second bones in the corrected configuration. 
     In another aspect, a first resecting guide aligns a resecting tool with a resection location on the first bone. 
     In another aspect, the first resecting guide includes first and second cannulas configured to be advanced over the first k-wire and a third k-wire, the third k-wire is parallel with the first k-wire. 
     In another aspect, a second resecting guide aligns the resecting tool with a resection location on the second bone. 
     According to another aspect, a method for correcting alignment between a first bone and a second bone by fusing a joint between the first bone and the second bone includes aligning a first end portion of a first guide with the first bone. The first end portion has a first cannula and a second cannula aligned in a first direction. A first k-wire is inserted through the first cannula and into the first bone and a second k-wire through the second cannula and into the first bone. A first end of the first bone is resected through a slot to form a first resected face. The slot aligns with the first end of the first bone by the first and second k-wires. A third k-wire and a fourth k-wire insert through the first guide into the second bone. A first end of the second bone is resected to form a second resected face. A second guide slides over the first, second, third and fourth k-wires to adjust a position of the first and second bones such that the first and second resected faces abut in a corrected configuration. The first and second bones are fixed in the corrected configuration. 
     In another aspect, the method includes fixing the first and second bones in the corrected configuration by inserting a stabilizing wire into the first and second bones. 
     In another aspect, the method includes fixing the first and second bones in the corrected configuration by attaching a first end of a bone plate with the first bone and a second end of the bone plate with the second bone such that the first and second bones are retained in the corrected configuration. 
     In another aspect, the method includes sliding the second guide over the first, second, third and fourth k-wires to translate the first resected face towards the second resected face. 
     In another aspect, the method includes sliding the second guide over the first, second, third and fourth k-wires to rotate alignment between the first bone and the second bone. 
     In another aspect, the third k-wire and the fourth k-wire are inserted into the second bone through a second end portion of the first guide including a third cannula and a fourth cannula. The third and fourth cannula are aligned in a second direction. 
     In another aspect, the first end of the second bone is resected through the slot. The slot is aligned with the first end of the second bone by the third and fourth k-wires. 
     In another aspect, the slot is on a resection guide including first and second apertures configured to align with the first and second k-wires. 
     In another aspect, the first bone is a metatarsal, the second bone is a medial cuneiform bone and the corrected configuration of the first and second bones corrects a bunion. 
     In another aspect, the second guide adjusts an angle of the first bone in three orthogonal planes between a deformed configuration and the corrected configuration. 
     In another aspect, the method includes removing the first guide from the first and second k-wires after resecting the first end of the second bone to form the second resected face. 
     In another aspect, the method includes removing the second guide and the first, second, third, and fourth k-wires from the first and second bones after fixing the first and second bones in the corrected configuration. 
     According to another aspect, a method for correcting alignment between a first bone and a second bone by fusing a joint between the first bone and the second bone includes positioning a cutting guide in a first position proximate to a first end of the first bone, the cutting guide including a cutting slot and a first and second cannula through the cutting guide. The cutting guide in the first position includes a first and second k-wire positioned through the first and second cannula and into the first bone. A first end of the first bone is resected through the cutting slot to form a first resected face. The cutting guide is removed from the first and second k-wires. The cutting guide is positioned in a second position proximate to a first end of the second bone. The cutting guide in the second position includes a third and fourth k-wires positioned through the first and second cannula and into the second bone. A first end of the second bone is resected through the cutting slot to form a second resected face. The cutting guide is removed from the third and fourth k-wires. A second guide slides over the first, second, third and fourth k-wires. The second guide adjusts a position of the first and second bones such that the first and second resected faces abut in a corrected configuration. The first and second bones are fixed in the corrected configuration. 
     In another aspect, positioning a first end portion of a first guide with the first bone, the first end portion having a third cannula and a fourth cannula, the third and fourth cannula aligned in a first direction and inserting the first k-wire through the third cannula and into the first bone and the second k-wire through the fourth cannula and into the first bone. 
     In another aspect, positioning a second end portion of the first guide with the second bone, the second end portion having a fifth cannula and a sixth cannula, the fifth and sixth cannula aligned in a second direction and inserting the third k-wire through the fifth cannula and into the second bone and the fourth k-wire through the sixth cannula and into the second bone. 
     In another aspect, fixing the first and second bones in the corrected configuration includes inserting a stabilizing wire into the first and second bones. 
     In another aspect, fixing the first and second bones in the corrected configuration includes attaching a first end of a bone plate with the first bone and a second end of the bone plate with the second bone such that the first and second bones are retained in the corrected configuration. 
     In another aspect, sliding the second guide over the first, second, third and fourth k-wires translates the first resected face towards the second resected face. 
     In another aspect, sliding the second guide over the first, second, third and fourth k-wires rotates the first bone relative to the second bone to adjust an alignment therebetween. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Various examples are depicted in the accompanying drawings for illustrative purposes, and should in no way be interpreted as limiting the scope of the examples. Various features of different disclosed examples can be combined to form additional examples, which are part of this disclosure. 
         FIG.  1    shows a top view of a patient&#39;s foot in a deformed configuration; 
         FIG.  2 A  shows a front perspective view of the alignment guide; 
         FIG.  2 B  shows a rear perspective view of the alignment guide; 
         FIG.  3 A  shows a front view of the alignment guide. 
         FIG.  3 B  shows a section view taken along the line  3 B- 3 B of  FIG.  3 A ; 
         FIG.  4    shows an exploded view of the alignment guide; 
         FIG.  5    shows an angle between cannula of the alignment guide; 
         FIG.  6    shows a second angle between cannula of the alignment guide; 
         FIG.  7    shows a third angle between cannula of the alignment guide; 
         FIG.  8    shows an alignment guide aligned with a medial cuneiform bone and a metatarsal bone in the patient&#39;s foot; 
         FIG.  9    shows insertion of a plurality of k-wires into the medial cuneiform bone and the metatarsal bone through the alignment guide; 
         FIG.  10 A  shows the removal of tubes of the alignment guide; 
         FIG.  10 B  shows the removal of the alignment guide from the k-wires; 
         FIG.  11 A  is a perspective view of an alignment guide including a guide body and an insert in accordance with an alternative embodiment; 
         FIG.  11 B  is another perspective view of the alignment guide illustrated in  FIG.  11 A ; 
         FIG.  12 A  is a perspective view of the guide body of  FIG.  11 A ; 
         FIG.  12 B  is another perspective view of the guide body of  FIG.  11 A ; 
         FIG.  12 C  is another perspective view of the guide body of  FIG.  11 A ; 
         FIG.  12 D  is another perspective view of the guide body of  FIG.  11 A ; 
         FIG.  12 E  is a side elevation view of the guide body of  FIG.  11 A ; 
         FIG.  12 F  is another side elevation view of the guide body of  FIG.  11 A ; 
         FIG.  12 G  is a top plan view of the guide body of  FIG.  11 A ; 
         FIG.  12 H  is a bottom plan view of the guide body of  FIG.  11 A ; 
         FIG.  12 I  is a front elevation view of the guide body of  FIG.  11 A ; 
         FIG.  12 J  is a rear elevation view of the guide body of  FIG.  11 A ; 
         FIG.  13 A  is a perspective view of the insert of  FIG.  11 A ; 
         FIG.  13 B  is an exploded perspective view of the guide body and the insert of  FIG.  11 A ; 
         FIG.  14 A  is a perspective view showing insertion of a joint alignment member into a tarsometatarsal (TMT) joint; 
         FIG.  14 B  is a perspective view of the joint alignment member of  FIG.  14 A ; 
         FIG.  14 C  is a perspective view of a joint alignment member constructed in accordance with another example; 
         FIG.  14 D  is a perspective view showing insertion of a guide body illustrated in  FIG.  11 A  onto the joint alignment member shown in  FIG.  14 A ; 
         FIG.  14 E  is a perspective view showing the insert of  FIG.  11 A  inserted into the guide body of  FIG.  14 D , and k-wires driven through the alignment guide and into the patient&#39;s foot; 
         FIG.  14 F  is a perspective view showing the insert removed from the guide body; 
         FIG.  14 G  is a perspective view of the guide body removed from the patient&#39;s foot; 
         FIG.  15 A  shows a perspective view of a resection guide; 
         FIG.  15 B  shows a front view of the resection guide; 
         FIG.  16 A  shows the alignment guide removed; 
         FIG.  16 B  shows installation of a first resection guide; 
         FIG.  17    shows the installation of a second resection guide; 
         FIG.  18 A  shows a perspective view of the correction guide; 
         FIG.  18 B  shows a top view of the correction guide; 
         FIG.  18 C  is a cross-sectional view of a correction guide in another example; 
         FIG.  19 A  shows a correction guide assembled over the plurality of k-wires to align the medial cuneiform bone and the metatarsal bone of the patient&#39;s foot into a corrected configuration; 
         FIG.  19 B  is another view showing the correction guide of  FIG.  19 A  assembled over the plurality of k-wires to align the medial cuneiform bone and the metatarsal bone of the patient&#39;s foot into a corrected configuration; 
         FIG.  20    shows the insertion of first and second fixing k-wires into the medial cuneiform bone and the metatarsal bone. 
         FIG.  21    shows the patient&#39;s foot with the plurality of k-wires removed; 
         FIG.  22    shows an exploded view of a bone plate assembly aligned with the medial cuneiform bone and the metatarsal bone in the corrected configuration; 
         FIG.  23    shows a top view of a bone plate; 
         FIG.  24    shows a side view of the bone plate; 
         FIG.  25    shows the bone plate assembly assembled with the medial cuneiform bone and metatarsal bone in the corrected configuration; 
         FIG.  26    shows a side view of the patient&#39;s foot in the corrected configuration; 
         FIG.  27    shows a method of calculating a correction factor using a virtual model; 
         FIG.  28 A  shows the virtual model in a virtual deformed configuration; 
         FIG.  28 B  shows the virtual model adjusted into a virtual corrected configuration; 
         FIG.  28 C  shows fixing two virtual axes in a first virtual bone and a second virtual bone, respectively, in the virtual corrected configuration; 
         FIG.  28 D  shows the virtual model returned to the virtual deformed configuration with the resultant orientation of the two virtual axes defining a correction factor for the virtual model; 
         FIG.  29    shows a method of manufacturing an alignment guide based on the correction factor; 
         FIG.  30 A  shows a side view of another implementation of an alignment guide; 
         FIG.  30 B  shows a top view of the alignment guide of  FIG.  30 A ; 
         FIG.  31    shows an exploded view of the alignment guide of  FIG.  30 A ; 
         FIG.  32 A  shows a perspective view of another implementation of a resection guide; 
         FIG.  32 B  shows a front view of the resection guide of  FIG.  32 A ; 
         FIG.  33    shows alignment of the alignment guide of  FIG.  30 A  with a patient&#39;s foot; 
         FIG.  34    shows insertion of a plurality of k-wires into a medial cuneiform bone and a metatarsal bone through the alignment guide; 
         FIG.  35    shows a partial disassembly of the alignment guide; 
         FIG.  36    shows the alignment guide removed and the installation of the resection guide of  FIG.  32 A ; 
         FIG.  37    shows a correction guide assembled over the plurality of k-wires to align the medial cuneiform bone and the metatarsal bone of the patient&#39;s foot into a corrected configuration and the insertion of a fixing k-wire. 
         FIG.  38    shows a bone plate assembly assembled with the medial cuneiform bone and metatarsal bone in the corrected configuration. 
     
    
    
     DETAILED DESCRIPTION 
     Overview 
     Bunion correction or repair is a common surgery with over 100,000 surgeries performed annually in the US. Many surgical procedures for bunion repair are invasive and painful, requiring an incision of several inches and a long period of convalescence, of up to 10-12 weeks. Minimally invasive surgery has been performed in orthopedics for decades. One common procedure is known as a Lapidus bunionectomy. In a Lapidus bunionectomy, the bunion is corrected at the great toe by adjusting alignment at the first tarsometatarsal joint. The metatarsal can also be stabilized using bone screws and/or a plate to facilitate fusion between the metatarsal and the medial cuneiform bone. 
     However, existing Lapidus bunionectomy procedures have various drawbacks and risks. These drawbacks include requiring more than minimally invasive surgery, the use of a realignment apparatus that exhibits little control over rotation and relative angles of the metatarsal bone, procedures that rely on in-surgery trial-and-error to identify the best alignment of the patient&#39;s foot bones and in-surgery judgment to identify locations for performing resections, lack of customization to account for individual patient foot conditions, and/or a lack of usable guides for performing pre-planned resections of the foot bones. Various aspects of the bone repositioning systems and procedures described herein overcome and improve upon these existing procedures, leading to better patient outcomes. 
     The various features and advantages of the systems, devices, and methods for bone repositioning described herein will become more fully apparent from the following description of the examples illustrated in the figures. These examples are intended to illustrate the principles of this disclosure, and this disclosure should not be limited to merely the illustrated examples. The features of the illustrated examples can be modified, combined, removed, and/or substituted as will be apparent to those of ordinary skill in the art upon consideration of the principles disclosed herein. 
     Deformation Correction Procedures 
       FIG.  1    shows a skeletal view of a patient&#39;s foot  100  having one or more bones in an initial or deformed configuration  102 . The deformed configuration  102  can be a bunion, as illustrated. In other examples, the deformed configuration can be a post-traumatic malunion of a fracture, or other single bone deformity that can be corrected across an osteotomy. The deformed configuration  102  can be a misalignment between a metatarsal  108  and a phalanx  112  of the patient&#39;s great toe. The metatarsal  108  can be at an angle with respect to the phalanx at  112 . A high degree of misalignment between the metatarsal  108  and the phalanx  112  can lead to severe pain and rubbing and discomfort and other problems in the patient&#39;s foot  100 . Accordingly, it can be beneficial to correct the alignment between the metatarsal  108  and the phalanx  112  of the great toe. 
     The patient&#39;s foot  100  can further include a medial cuneiform bone  104 . The medial cuneiform bone  104  can be connected with a proximal end of the first metatarsal  108  (e.g., by one or more ligaments). A tarsometatarsal (TMT) joint joins the medial cuneiform bone  104  to the first metatarsal  108 . Thus, reference below is made to the TMT joint. Therefore, while the medial cuneiform bone  104  and the first metatarsal  108  can define first and second bones, respectively, it should be appreciated that first and second bones can apply to any alternative anatomical bones or bone segments that are separated by any suitable joint or, alternatively, an osteotomy. Accordingly, description below to the TMT joint can apply to other joints or, alternatively, an osteotomy. A distal direction is defined from the medial cuneiform bone  104  toward the metatarsal  108 . Conversely, a proximal direction is defined from the metatarsal  108  toward the medial cuneiform bone  104 .  FIGS.  1 - 22    illustrate systems and methods of correcting alignment between the medial cuneiform bone  104  and the metatarsal  108 . In turn, proper alignment between the medial cuneiform bone  104  and the metatarsal  108  can correct alignment between the metatarsal  108  and the phalanx  112 . Accordingly, the deformed configuration  102  of the patient&#39;s foot  100  can be corrected. The present disclosure relates to systems and methods for correcting the deformed configuration  102 . Moreover, the systems and methods described herein can be used more generally for correcting alignment between any two bones a patient&#39;s body. 
     As shown in  FIGS.  2 A- 4   , the system for correcting alignment in the patient&#39;s foot  100  can include an alignment guide  200 . The alignment guide  200  can be formed of a rigid material. The alignment guide  200  can include a first end portion  204 . The first end portion  204  can include one or more apertures  210   a ,  212   a . Although two apertures are described and illustrated, more or fewer apertures can be included on the first end portion  204 . The apertures  210   a ,  212   a  can include internal threads  221 ,  222 , respectively. The apertures  210   a ,  212   a  can be chamfered on one or both sides of the alignment guide  200 . The apertures  210   a ,  212   a  can extend all the way through the alignment guide  200 . The apertures  210   a ,  212   a  can be aligned along respective axes  230 ,  232 . The axes  230 ,  232  can be parallel. Alternatively, the axes  230 ,  232  can be converging. The axes  230 ,  232  can be spaced apart a distance  204   a . The distance  204   a  can be based on a length of the medial cuneiform bone  104 . 
     As shown in  FIG.  4   , the alignment guide  200  can define at least one proximal cannula  213  (see  FIG.  5   ), such as first and second proximal cannulas  210  and  212 . The first and second cannulas  210  and  212  can be referred to as first and second proximal cannulas, respectively. In particular, the alignment guide  200  can include one or more removable tubes  240 ,  242 . The removable tubes  240  can include a first end  240   a  and a second end  240   b . The first end  240   a  can be received within the aperture  210   a . The removable tube  240  can include a threaded portion  244 . The threaded portion  244  can engage with the internal threads  221  of the aperture  210   a . The removable tubes  242  can include a first end  242   a  and a second end  242   b . The first end  242   a  can be received within the aperture  212   a . The removable tube  240  can include a threaded portion  246 . The threaded portion  246  can engage with the internal threads  222  of the aperture  212   a.    
     The removable tube  240  can define the first cannula  210 . When installed within the aperture  210   a , the first cannula  210  can be aligned along the axis  230  of the aperture  210   a . The removable tube  242  can define the second cannula  212 . When installed within the aperture  212   a , the second cannula  212  can be aligned along the axis  232  of the aperture  212   a . The first and second cannulas  210  and  212  can define different diameters therethrough. The cannula  212  can have a greater diameter than the cannula  210  (or vice-versa). In other implementations, the first and second cannulas  210  and  212  can define the same different diameters therethrough. In other implementations, the first and second cannulas  210  and  212  can define varying diameters therethrough. 
     The alignment guide  200  can include a second portion  208 . The second end portion  208  can include at least one distal cannula  215  such as third and fourth cannulas  214  and  216 . The second portion  208  can define a distal end portion of the alignment guide  200 , and the at least one cannula can define at least one distal cannula. The third and fourth cannulas  214  and  216  can be defined through a body of the alignment guide  200  and/or through respect extensions  219 ,  218  thereof. Although two cannula are described and illustrated, more or fewer cannulas can be included on the second end portion  208 . Moreover, the second end portion  208  can include removable inserts or removable portions (e.g., removable tubes) around the third and fourth cannula  214  and  216 . The third and fourth cannulas  214  and  216  can also be referred to as first and second distal cannulas  214  and  216  respectively. 
     The third and fourth cannulas  214  and  216  can extend all the way through the alignment guide  200  (e.g., including the extensions  218 ,  219 ). The third and fourth cannulas  214  and  216  can define different diameters therethrough. The third cannula  214  can have a greater diameter than the fourth cannula  216  (or vice-versa). In other implementations, the third and fourth cannulas  214  and  216  can define the same different diameters therethrough. In other implementations, the third and fourth cannulas  214  and  216  can define varying diameters therethrough. 
     The third and fourth cannula  214  and  216  can be aligned along respective parallel axes  234 ,  236 . The axes  234 ,  236  can be spaced apart a distance  208   a . The distance  204   a  can be based on a length of the metatarsal bone  108 . 
       FIGS.  5 - 7    shows the assembled alignment guide  200 . The first end portion  204  can define a position and orientation of a first set of cannula (e.g., cannula  210 ,  212 ). The second end portion  208  can define a position and orientation of a second set of cannula (e.g., the third and fourth cannula  214  and  216 ). The first set of cannula and the second set of cannula can be offset from each other and/or angled with respect to each other. 
       FIG.  5    shows an angle α between the axis  230  of the first cannula  210  and the axis  236  of the fourth cannula  216 . The angle α defines the relative orientation angle between the first set of cannula on the first end  204  and the second set of cannula on the second end  208 . The angle α can be defined in an z-x plane in a Cartesian coordinate system (having x, y, and z axes). The cannula first  210  can include a point PA. Alternatively, the point PA can be any fixed position along the first cannula  210 . The point PA can have an x, y, and z coordinate location in a Cartesian coordinate system (having x, y, and z axes). The cannula  216  can include a point PB. Alternatively, the point PB can be any fixed position along the fourth cannula  216 . The point PB can have an x, y, and z coordinate location in the Cartesian coordinate system. The points PA and PB can define a relative position of the axes  230 ,  236  in the Cartesian coordinate system. 
       FIG.  6    shows an angle β between the axis  230  of the first cannula  210  and the axis  236  of the fourth cannula  216 . The angle β defines the relative orientation angle between the first set of cannula on the first end  204  and the second set of cannula on the second end  208  in a y-x plane.  FIG.  7    shows an angle γ between the axis  230  of the first cannula  210  and the axis  236  of the fourth cannula  216 . The angle γ defines the relative orientation angle between the first set of cannula on the first end  204  and the second set of cannula on the second end  208  in a y-z plane. 
     Together, the relative positions of the points PA and PB and at least two of the relative angles α, β, and γ can define the axis of the cannula on the alignment guide  200 . Using the proper selection of the relative angles α, β, and/or γ, and/or the relative positions of the points PA and PB of the alignment guide  200  can be used to correctly align the bones in the patient&#39;s foot  100 , as described further below. 
     As shown in  FIG.  8   , the alignment guide  200  can be aligned with the patient&#39;s foot  100 . The first end portion  204  can be generally aligned with the medial cuneiform bone  104 . The second end portion  208  can be generally aligned with the metatarsal  108 . As shown in  FIG.  9   , a plurality of temporary fixation elements such as k-wires  250  can be extended through respective cannula of the alignment guide  200 . At least one of the k-wires can extend through a respective cannula and into the respective medial cuneiform  104 , and at least another of the k-wires can extend through a respective cannula of the alignment guide  200  and into the metatarsal bone  108 . 
     At least one proximal temporary fixation device, such as at least one proximal k-wire, can be inserted through the at least one proximal cannula of the alignment guide  200  and into the cuneiform bone  104 . For instance, a first k-wire  252  can be driven through the cannula  210  and into the medial cuneiform  104 . The first k-wire  252  can be inserted at a first insertion point  254  on the medial cuneiform bone  104 . A second k-wire  256  can be driven through the cannula  212  and into the medial cuneiform bone  104 . The second k-wire  256  can be inserted through the medial cuneiform bone  104  at a second insertion point  258 . The first and second k-wires  252  and  256  can be referred to as first and second proximal k-wires respectively. The first and second insertion points  254  and  258  can be referred to as proximal insertion points. 
     At least one distal temporary fixation device, such as at least one distal k-wire, can be inserted through the at least one distal cannula of the alignment guide  200  and into the metatarsal  108 . A third k-wire  260  can be driven through the cannula  214  and into the metatarsal  108 . The third k-wire  260  can intersect and be inserted into the metatarsal  108  at a third insertion point  262 . A fourth k-wire  264  can be driven through the fourth cannula  216  and into the metatarsal  108 . The fourth k-wire  264  can be inserted into the metatarsal  108  at a fourth insertion point  266 . The third and fourth k-wires  260  and  264  can be referred to as first and second distal k-wires respectively. The third and fourth insertion points  262  and  266  can be referred to as first and second distal insertion points respectively. The alignment guide  200  can be positioned such that the first and second cannulas  210  and  212  and the third and fourth cannulas  214  and  216 , and thus the first and second k-wires  252  and  256  and the third and fourth k-wire  260  and  264 , extend medially from the medial cuneiform bone  104  and the first metatarsal  108 , respectively. Alternatively, the alignment guide  200  can be positioned such that the first and second cannulas  210  and  212  and the third and fourth cannulas  214  and  216 , and thus the first and second k-wires  252  and  256  and the third and fourth k-wire  260  and  264 , extend superiorly from the medial cuneiform bone  104  and the first metatarsal  108 , respectively, as described below with respect to the alignment guide  300  (see  FIGS.  11 A- 14 G ). 
     The first and second k-wires  252 ,  256  can be parallel with each other, based on the parallel cannula  210 ,  212 . The third and fourth k-wires  260 ,  264  can be parallel with each other, based on the cannula  214 ,  216 . One or more of the insertion points  254 ,  258 ,  262 ,  266  (e.g., at least one on each bone  104 ,  108 ) can be in predetermined locations on the patient&#39;s foot. The lengths of the extensions  218 ,  219  and/or the tubes  240 ,  242  can provide greater stability to the k-wires  250  that are received therein. Diameters of the k-wires  250  can be sized according to the diameters of the respective cannula of the alignment guide  200  to ensure accurate insertion at angles into the bone  104 ,  108 . Moreover, the k-wires  250  can be matched to the correct cannula based on different diameter sizes. 
     The first and second k-wires  252  and  256  can be referred to as proximal k-wires  251 , and the third and fourth k-wires  260  and  264  can be referred to as distal k-wires  253  that are disposed distal of the proximal k-wires  251 . The first and second cannulas  210  and  212  of the alignment guide  200  can be referred to as proximal cannulas of the alignment guide. The third and fourth cannulas  214  and  216  of the alignment guide can be referred to as distal cannulas of the alignment guide  200  that are disposed distal of the proximal cannulas of the alignment guide  200 . The proximal k-wires  251  are configured to be inserted into respective ones of the proximal cannulas  213  and into the cuneiform bone  104 . The distal k-wires  253  are configured to be inserted into respective ones of the distal cannulas and into the metatarsal  108 . While the system can include two proximal k-wires  251  and two distal k-wires  253  in one example, it should be appreciated that the system can include any number of proximal and distal k-wires including at least one. Thus, at least one proximal k-wire  251  can be inserted through at least one proximal cannula  213  and into the cuneiform bone  104 , and at least one distal k-wire  253  can be inserted through at least one distal cannula  215  and into the metatarsal  108 . 
       FIG.  10 A- 10 B  show removal of the tubes  240 ,  242  from the first end  204  of the alignment guide  200 . The first and second tubes  240 ,  242  are removed from the first end portion  204  to allow the alignment guide  200  to subsequently be removed from the plurality of k-wires  250  inserted within the medial cuneiform bone and metatarsal bone  108 , also referred to as the proximal k-wires  251 .  FIG.  10 B  shows the removal of the alignment guide  200  from the k-wires  250 . In certain circumstances, without a removable or otherwise deconstructable element, it can be difficult for a user to remove the alignment guide  200  from the plurality of k-wires  250  because of the misalignment between the first and second ends  204 ,  208 . Once the first and second tubes  240  and  242  have been removed, the openings  210   a  and  212   a  (see  FIG.  4   ) have respective sizes greater than those of the proximal k-wires  251 , thereby providing clearance between the alignment guide  200  and the proximal k-wires  251 . Thus, the alignment guide  200  can ride along the distal k-wires  253  as it is removed, while the clearance allows the alignment guide  200  to be removed from the proximal k-wires  252 . 
     Referring now to  FIGS.  11 A- 14 E  in general, an alignment guide  300  can be constructed in accordance with an alternative embodiment. The alignment guide  300  can include a guide body  301  and an insert  311  that is configured to be supported by the guide body  301 . The guide body  301  can be formed of a rigid material, and in particular can be formed from a solid block of material. Thus, the guide body  301  can define a unitary monolithic one-piece structure. Similarly, the insert  311  can be formed of a rigid material, and in particular can be formed from a solid block of material. Thus, the insert  311  can define a unitary monolithic one-piece structure. As will now be described, the alignment guide  300  can define at least one proximal cannula and at least one distal cannula that are configured to receive respective temporary fixation elements, such as k-wires, that are secured to bones or bone segments, such as the medial cuneiform bone  104  and the first metatarsal  108 , respectively at a predetermined relative position. For instance, the at least one proximal cannula can be defined by the guide body  301 , and the at least one distal cannula can be defined by the insert  311 . Alternatively, the at least one distal cannula can be defined by the guide body  301 , and the at least one proximal cannula can be defined by the insert  311 . While k-wires are described and shown, it should be appreciated that the temporary fixation elements can be alternatively constructed in any manner as desired. For instance, the temporary fixation elements can define pins, nails, or the like. 
     Referring now to  FIGS.  11 A- 12 J  in particular, the alignment guide  300  can include a guide body  301  that defines a bone-facing surface  303  and an outer surface  305  opposite the bone-facing surface  303 . The alignment guide has a first or proximal end portion  304  and a second or distal end portion  308 . The second end portion  308  extends distally from the first end portion  304 . 
     The alignment guide  300  can include at least one first or proximal cannula, such as a first cannula  310  and a second cannula  312  that extend through the guide body  301  from the outer surface  305  to the bone-facing surface  303 . The first and second cannulas  310  and  312  can be referred to as first and second proximal cannulas. In one example, the first and second cannulas  310  and  312  can extend through the first end portion  304 . The first and second cannulas  310  and  312  can be arranged such that the second cannula  312  is offset from the first cannula  310  in the distal direction. The first and second cannulas  310  and  312  can extend through the guide body  301  along respective first and second central axes  330  and  332 . In one example, the central axes  330  and  332  can be parallel to each other as they extend in a direction from the outer surface  305  to the bone-facing surface  303  (also referred to as a bone-facing direction). Alternatively, the central axes  330  and  332  can diverge from each other as they extend in the bone-facing direction. Alternatively still, the central axes  330  and  332  can converge toward each other as they extend in the bone-facing direction. The cannulas  310  and  312  can be chamfered at either or both of the outer surface  305  and the bone-facing surface  303 . The central axes  330  and  332  can be spaced apart from each other along a first direction a distance  307  that is based on a length of the cuneiform bone  104 . Therefore, the system can include a kit of alignment guides  300  having different distances  304  as desired. Although the at least one proximal cannula is shown and described as including two cannulas, more or fewer cannulas can be defined by the at least one proximal cannula. 
     As will be described in more detail below, the first and second cannulas  310  and  312  can each be sized and configured to receive respective first and second k-wires  252  and  256  (see  FIG.  14 E ). The first and second cannulas  310  and  312  can define different diameters therethrough. The first cannula  310  can have a greater diameter than the second cannula  312 . Alternatively, the second cannula  312  can have a greater diameter than the first cannula  310 . In other implementations, the first and second cannulas  310  and  312  can define the same diameters therethrough. In other implementations, either or both of the first and second cannulas  310  and  312  can define varying diameters therethrough. 
     It should be appreciated that in one example, the first and second cannulas  310  and  312  can be defined by the guide body  301 . In another example described above with respect to the alignment guide  200 , the first and second cannulas  310  and  312  can be defined by respective removable tubes of the alignment guide  300  that are inserted into respective apertures of the guide body  301 . In both examples, it can be said that the alignment guide  300  defines the first and second cannulas  310  and  312 . 
     The alignment guide  300  can further define at least one second or distal cannula such as third and fourth cannulas  314  and  316 . The third and fourth cannulas  314  and  316  can also be referred to as first and second distal cannulas. In particular, the alignment guide  300  can define a receiving aperture  313  that extends through the guide body  301  along the bone-facing direction. For instance, the aperture  313  can extend through the second end portion  308  of the guide body  301 . The aperture  313  can be sized and configured to receive the insert  311 . In particular, the insert  311  can be removably inserted into the aperture  313 . The aperture  313  can be open to a medial side of the second end portion  308  at a side opening  315  that can extend laterally into the second end portion  308 . Further, the aperture  313  can extend from the outer surface  305  to the bone-facing surface  303 . Respective ends  371  that define the proximal and distal ends of the opening  315  can be disposed outboard of the cannulas of the insert  311 , as will now be described. 
     Referring now to  FIGS.  13 A- 13 B , the insert  311  can define an insert portion  368  and a seat portion  370 . The insert portion defines a bone-facing surface  371  of the insert  311 , and the seat portion  370  can define an outer surface  373  of the insert  311  that is opposite the bone-facing surface  371 . The insert can define third and fourth cannulas  314  and  316  that extend from the outer surface  373  to the bone-facing surface  371 . The third and fourth cannulas  314  and  316  can be referred to as first and second distal cannulas, respectively, when the aperture  313  that receives the insert  311  extends through the second end portion  308 . Although the insert  311  is illustrated and described as defining two cannulas, the insert  311  can define more or fewer cannulas as desired. 
     The third and fourth cannulas  314  and  316  can extend along respective third and fourth central axes  334  and  336 , respectively, through the insert  311 . The third and fourth cannulas  314  and  316  can define different diameters therethrough. The third cannula  314  can have a greater diameter than the fourth cannula  316 . Alternatively, the fourth cannula  316  can have a greater diameter than the third cannula  314 . In other implementations, the third and fourth cannulas  314  and  316  can define the same different diameters therethrough. In other implementations, either or both of the third and fourth cannulas  314  and  316  can define varying diameters therethrough. 
     In one example, the central axes  334  and  336  can extend parallel to each other as they extend in a direction from the outer surface  373  to the bone-facing surface  371  (also referred to as a bone-facing direction). Alternatively, the central axes  334  and  336  can diverge from each other as they extend in the bone-facing direction. Alternatively still, the central axes  334  and  336  can converge toward each other as they extend in the bone-facing direction. The axes  334  and  336  can be spaced apart a longitudinal distance  309  along a second direction. The distance  309  can be based on a length of the metatarsal bone  108 . The second direction can be different than the first direction along which the first and second axes  330  and  332  are spaced from each other. The orientation and position of the cannulas  310 ,  312 ,  314 , and  316  can be selected to correct a deformity, such as a bunion as described above. The kit of alignment guides  300  can have different distances  309  as desired. The opening  315  to the aperture  313  can have a longitudinal distance greater than the distance  309  so as to accommodate the distal k-wires upon removal of the guide body  301  from the patient&#39;s foot  100 . Although the at least one distal cannula is shown and described as including two cannulas, more or fewer cannulas can be defined by the at least one distal cannula. The cannulas  314  and  316  can be chamfered at either or both of the outer surface  373  and the bone-facing surface  371 . 
     The insert portion  368  of the insert  311  can define a shoulder  380 . In particular, the seat portion  370  can have a cross-sectional dimension perpendicular to the bone-facing direction that is greater than a corresponding cross-sectional dimension of the aperture  313 . Accordingly, the seat portion  370  is sized so that it is not insertable into or through the aperture  313  of the guide body  301  in the bone-facing direction. The insert portion  368  is sized for insertion through the aperture  313  in the bone-facing direction. Therefore, the extent of the seat portion  370  that extends out with respect to the insert portion  368  in a direction perpendicular to the bone-facing direction can define the shoulder  380 . The shoulder  380  can extend partially or fully about the insert portion  368  along a direction that is orthogonal to a direction along which the insert portion  368  extends from the seat portion  370 . During operation, as shown at  FIG.  11 A , the insertion portion  368  can be inserted through the aperture  313  until the seat portion  370 , and in particular the shoulder  380 , abuts the outer surface  305  of the guide body  301 , thereby limiting a depth of insertion of the insert  311  through the aperture  313 . The aperture  313  can be inwardly tapered as it extends from the outer surface  305  to the bone-facing surface  303 , or can be substantially constantly dimensioned in cross-section from the outer surface  305  to the bone-facing surface  303  as desired. The insert  311  can be similarly dimensioned in cross-section so as to substantially match the cross-sectional dimension of the aperture  313 . When tapered, the taper can fix the depth of insertion of the insert  311  through the aperture  313 . In other examples, the guide body  301  can include a floor portion that extends into or across aperture  313 , which can define a seat for the insert  311  so as to fix the depth of insertion of the insert through the aperture  313 . 
     The guide body  301  and the insert  311  can be fabricated in accordance with any suitable method as desired. In one example, the guide body  301  can be made by a rapid-prototyping or CNC machining method to include the aperture  313  and the first and second cannulas  310  and  312  in respective predetermined positions and orientations to correct a deformity of the foot using the methods described herein. As another example, a plurality of blank guide bodies  301  can be fabricated the aperture  313 , and the first and second cannulas  310  and  312  can be subsequently drilled or otherwise formed as desired. 
     Referring also to  FIGS.  11 A- 11 B , the insert  311  can be inserted through the aperture  313  such that seat portion  370  sits atop the outer surface  305  of the guide body  301 . The insert portion  368  can extend through the guide body  301  to the bone-facing surface  371  which can be offset with respect to the bone-facing surface  303  of the guide body  301  in the bone-facing direction. The insert portion  386  can have a height along the bone-facing direction that is greater than the height of the guide body  301  at the aperture  313 . The height of the insert portion  386  can be measured from the shoulder  380  to the bone-facing surface  371  of the insert  311 . The height of the guide body  301  can be measured from the outer surface  305  to the bone-facing surface  303  of the guide body  301 . As will be described in more detail below, the height of the insert portion can be sized such that the bone-facing surface  371  at the insert portion  368  abuts the metatarsal  108  when the bone-facing surface  303  at the first end portion  304  abuts the cuneiform bone  104 . 
     It should be appreciated that as described above with respect to the alignment guide  200 , the alignment guide  300  can define the angle α between the central axis  330  of the first cannula  310  and the axis  236  of the fourth cannula  316  (see  FIG.  5   ), the angle β between the axis  330  of the first cannula  310  and the axis  236  of the fourth cannula  316  (see  FIG.  6   ), and the angle γ between the axis  330  of the first cannula  310  and the axis  236  of the fourth cannula  316  (see  FIG.  7   ). It should further be appreciated that the system can include a plurality of inserts that define different values of at least one of the angles α, β, and γ as desired. 
     Referring again to  FIGS.  12 A- 12 J , the second or distal end portion  308  of the guide body  301  can be offset with respect to the first or proximal end portion  304  in the medial direction. In particular, the guide body  301  can include an intermediate portion  317  that extends from the first end portion  304  to the second end portion  308 . In one example, the intermediate portion  317  extends from the distal end of the first end portion  304  to the proximal end of the second end portion  308 . In one example, the first and second end portions  304  and  308  and the intermediate portion  317  can be monolithic with each other so as to define a one-piece unitary body. Alternatively, either or both of the first and second end portions  304  and  308  can be separate from the intermediate portion  317  and attached to the intermediate portion  317  in any suitable manner as desired. 
     The guide  300  can further include a joint alignment cannula  319  that extends through the guide body  301  at a location between the proximal cannulas and the aperture  313 . The joint alignment cannula  319  is configured to receive a joint alignment member # that is configured to be driven into a joint  369  that is defined by medial cuneiform bone  104  and the first metatarsal  108  (see  FIG.  14 D ), thereby aligning the alignment guide  300  with the body  301  with the joint  369 , which can define a tarsometatarsal joint in some examples. The position of the joint alignment cannula  319  can set a spacing of the first end portion  304  of the guide body  301  relative to the medial cuneiform bone  104  and set a spacing of the second end portion  308  relative to the metatarsal  108  (see  FIG.  14 E ). 
     In one example, the joint alignment cannula  319  can extend through the intermediate portion  317 . Thus, the joint alignment cannula  319  can be disposed distal of the first and second cannulas  310  and  312 . The joint alignment cannula  319  can extend from the outer surface  305  to the inner surface  303  along a respective central axis  321 . In one example, the central axis  321  can lie on a common plane with the first and second central axes  330  and  332 . The central axis  321  can be oriented parallel with the first and second central axes  330  and  332 . Alternatively, the central axis  321  can be angularly offset with respect to the first and second central axes  330  and  332  within the common plane. The joint alignment cannula  319  can have a diameter that is different than the diameter of either or both of the first and second cannulas  310  and  312 . For instance, the diameter of the joint alignment cannula  319  can be greater than the diameter of either or both of the first and second cannulas  310  and  312 . Thus, a k-wire that fits through the joint alignment cannula  319  can be sized too big to fit through either of the first and second cannulas  310  and  312 . Alternatively, the diameter of the joint alignment cannula  319  can be equal to the diameter of the first and second cannulas  310  and  312 . 
     The first end portion  304  can define a position and orientation of a first set of cannula (e.g., cannulas  310  and  312 ). The second end portion  308  and the insert  311  can define a position and orientation of a second set of cannula (e.g., the third and fourth cannula  314  and  316 ). The first set of cannula and the second set of cannula can be offset from each other and/or angled with respect to each other as described herein. 
     During operation, referring to  FIG.  14 A- 14 B , a joint alignment member  372  can be inserted into a joint  369  that is defined by medial cuneiform bone  104  and the first metatarsal  108 . The joint alignment member  372  can be configured as a joint paddle having a paddle portion  376  and a shaft  375  that extends out from the paddle portion  376  along a central axis  378  that can also define a central axis of the paddle portion  376 . The joint alignment member  372  can be inserted into the joint  369  along a predetermined trajectory that is parallel to the joint  369 . Thus, the joint alignment member  372  can be driven along a direction from the dorsal side to the plantar side, such that a central axis  378  of the joint alignment member  372  extends along a declination angle of the joint  369 . The joint  369  can be referred to as the tarsometatarsal (TMT) joint. The trajectory along which the joint alignment member is inserted into the joint  369  can further be an inferior direction, or a combination of inferior and lateral directions. Thus, the shaft  375  can extend out from the paddle portion  376  in the superior direction alone or in combination with the medial direction. Any suitable imaging source, such as x-ray, can confirm that the joint alignment member  372  is parallel with the joint. If not, the joint alignment member  372  can be manipulated and repositioned, or removed and reinserted until it has been confirmed to be oriented parallel to the joint  369 . As will be appreciated from the description below, the joint alignment member  372  can be configured to align the alignment guide  300  with the tarsometatarsal joint  369  between the medial cuneiform bone  104  and the metatarsal  108 . 
     The shaft  375  and paddle portion  376  can be a single monolithic structure, or can be detachable from each other as desired. The paddle portion  276  can define first and second major surfaces  382  and  384  that are opposite each other along a first select direction that is perpendicular to the central axis  378 . The central axis  378  can be angularly offset with respect to the central axes of the third and fourth k-wires with respect to a view from the frontal plane when the alignment guide  300  is installed over the shaft  375  and the k-wires  260  and  264  (see also  FIG.  14 E ). The paddle portion  276  can further include first and second sides  385  that each extend from the first major surface  382  to the second major surface  384 . The first and second sides  385  can be opposite each other along a second direction that is perpendicular to each of the first select direction and the central axis  378 . The paddle portion  276  can be inserted into the joint  369  such that one of the major surfaces  382  faces the cuneiform bone  104 , and the other of the major surfaces  382  and  384  faces the metatarsal bone  108 . The joint alignment member  372  can be reversible, such that the paddle portion  376  can be inserted into the joint  369  in a first orientation or a second orientation. In the first orientation, the first major surface  382  faces the cuneiform bone  104  and the second major surface  384  faces the metatarsal  108 . In the second orientation, the first major surface  382  faces the metatarsal  108 , and the second major surface  384  faces the cuneiform bone  104 . In other examples, the joint alignment member  372  can be keyed so as to be insertable into the joint  369  in only one of the first and second orientations, and not in the other of the first and second orientations. 
     The paddle portion  376  can define a leading end  388  with respect to insertion into the joint  369 , and a trailing end  390  opposite the leading end  388 . The leading end  388  can be spaced from the trailing end  390  in a leading direction along the central axis  378 . The shaft  375  can extend out from the trailing end  390 . The first major surface  382  can define a first leading portion  382   a  and a first trailing portion  382   b . The first leading portion  382   a  can extend from the first trailing portion  382   b  in the leading direction. Similarly, the second major surface  384  can define a second leading portion  384   a  and a second trailing portion  384   b . The second leading portion  384   a  can extend from the second trailing portion  384   b  in the leading direction. At least respective portions up to respective entireties of the first leading portion  382   a  and the second leading portion  384   a  can be tapered toward each other as they extend in the leading direction to the leading end  388 . The taper can assist with insertion of the paddle portion  376  into the joint  369 . The paddle portion  376  can further include first and second notches  381  that extend into the sides  385  inwardly along the second select direction toward the central axis  378 . 
     The first and second trailing portions  382   b  and  384   b  can be oriented substantially parallel to each other. Further, the first and second trailing portions  382   b  and  384   b  can be spaced from each other along the first select direction any suitable distance between from approximately 1 mm to approximately 4 mm, such as from approximately 2 mm to approximately 3 mm. In one example, the distance can be approximately 2.5 mm. Thus, the paddle portion  376  can keep the joint  369  in tension when the paddle portion  376  is inserted into the joint  369 . In particular, one of the first and second trailing portions  382   b  and  384   b  can face and bear against the cuneiform bone  104 , and the other of the first and second trailing portions  382   b  and  384   b  can face and bear against the metatarsal  108 . 
     In one example, the first and second major surfaces  382  and  384  can be smooth and untextured. Further, each of the first and second leading portions  382   a  and  384   a  and each of the first and second trailing portions  282   b  and  284   b  can be planar or alternatively shaped as desired. The paddle portion  376  can be inserted smoothly into the joint  369 . Referring now to  FIG.  14 C , in another example, the paddle portion  376  can include one or more cutting teeth  379 , such as a plurality of cutting teeth  379 , or can otherwise have surface roughening. The cutting teeth  379  or surface roughening can be defined by either or both of the first leading portion  382   a  and the first trailing portion  382   b . The cutting teeth  379  can further be defined by either or both of the second leading portion  384   a  and the second trailing portion  384   b . Thus, the cutting teeth  379  can be disposed at respective portions of the first and second major surfaces  382  and  384  that contact the medial cuneiform  104  and the metatarsal bone  108  when the paddle portion  376  is inserted into the joint  376 . The cutting teeth  379  can have any shape and size as desired. For instance, the cutting teeth  379  can be oriented along the second select direction. The cutting teeth  379  can be parallel to each other or angularly offset from each other as desired. 
     During operation, the joint alignment member  372  is driven distally such that the leading end  388  is inserted into the joint  369 . The joint alignment member  372 , and in particular the leading end  388  can be inserted into the joint  369  by translating the joint alignment member  372  distally without undergoing rotation. As the first and second major surfaces  382  and  384  are inserted into the joint  369 , the cutting teeth  379 , if present, cut into either or both of the distal end of the medial cuneiform  104  and the proximal end of the first metatarsal  108  that define the joint  369 . It should be appreciated that once the joint alignment member  372  has been inserted into the joint  369 , the paddle portion  376  maintains the joint  369  in tension. Thus, the distal end of the medial cuneiform bone  104  and the proximal end of the first metatarsal  108  apply a compressive retention force onto the joint alignment member  372 , and in particular onto the paddle portion  376 , that retains the joint alignment member  372  in the joint  369  along the desired predetermined trajectory. 
     Next, referring to  FIG.  14 D , the alignment guide  300  can be placed adjacent the joint alignment member  372  such that the joint alignment cannula  319  is aligned with the shaft  375 . The alignment guide  300  is then brought toward the patient&#39;s foot  100 , which causes the shaft  375  to be inserted into the joint alignment cannula  319 . Otherwise stated, the joint alignment cannula  319  can be driven over the joint alignment member shaft  375  as the alignment guide  300  is brought toward the patient&#39;s foot. The first and second cannulas  310  and  312  have a predetermined spacing with respect to the joint alignment cannula  319 , Accordingly, when the joint alignment member  372  is disposed in the joint  369 , the first and second cannulas  310  and  312  are aligned with the medial cuneiform bone  104 , and the insert-receiving aperture  313  is aligned with the first metatarsal  108 . 
     Next, referring to  FIGS.  14 D- 14 E , the insert  311  can be received in the aperture in the manner described above. The alignment guide  300  can be positioned such that the first and second cannulas  310  and  312  are aligned with the medial cuneiform bone  104 , and the third and fourth cannulas  314  and  316  are aligned with the first metatarsal  108 . The alignment guide  300  can be placed against the patient&#39;s foot  100  such that the bone-facing surface  303  of the guide body  301  is disposed adjacent to or abuts the medial cuneiform bone  104 , and the bone-facing surface  371  of the insert  311  is disposed adjacent to or abuts the first metatarsal  108 . A plurality of temporary fixation elements such as k-wires  250  can be extended through respective cannula of the alignment guide  300  and into the patient&#39;s foot  100 . In particular, at least one of the k-wires can extend through a respective cannula of the alignment guide  300  and into the respective medial cuneiform  104 , and at least another of the k-wires can extend through a respective cannula of the alignment guide  300  and the first metatarsal bone  108 . 
     At least one proximal temporary fixation device, such as at least one proximal k-wire, can be inserted through the at least one proximal cannula of the alignment guide  300  and into the medial cuneiform bone  104 . For instance, a first k-wire  252  can be driven through the first cannula  310  and into the medial cuneiform  104 . The first cannula  310  can be sized to guide the first k-wire  252  along the first central axis  330  as it is driven into the medial cuneiform bone  104 . A second k-wire  256  can be driven through the cannula  312  and into the medial cuneiform bone  104 . The second cannula  312  can be sized to guide the second k-wire  256  along the second central axis  332  as it is driven into the medial cuneiform bone  104 . The first and second k-wires  354  and  356  can be referred to as first and second proximal k-wires respectively. The second cannula  312  and the second k-wire  256  can be disposed distal of the first cannula  310  and the first k-wire  252 . The first and second k-wires  252  and  256  can be referred to as proximal k-wires. 
     At least one distal temporary fixation device, such as at least one distal k-wire, can be inserted through the at least one distal cannula of the alignment guide  300  and into the metatarsal  108 . For instance, a third k-wire  260  can be driven through the third cannula  314  and into the first metatarsal  108 . The third cannula  314  can be sized to guide the third k-wire  260  along the third central axis  334  (see  FIG.  13 A ) as it is driven into the first metatarsal  108 . A fourth k-wire  264  can be inserted through the fourth cannula  316  and into the first metatarsal  108 . The fourth cannula  316  can be sized to guide the fourth k-wire  264  along the fourth central axis  336  (see  FIG.  13 A ) as it is driven into the first metatarsal  108 . The fourth cannula  316  and the fourth k-wire  264  can be disposed distal of the third cannula  314  and the third k-wire  260 . The third and fourth k-wires  260  and  264  can be referred to as first and second distal k-wires respectively that are disposed distal of the proximal k-wires. The first and second k-wires  252  and  256  can be on opposite sides of the joint  369  with respect to the third and fourth k-wires  260  and  264 . 
     The alignment guide  300  can be positioned such that the first and second cannulas  310  and  312  and the third and fourth cannulas  314  and  316 , and thus the first and second k-wires  252  and  256  and the third and fourth k-wire  260  and  264 , extend superiorly from the medial cuneiform bone  104  and the first metatarsal  108 , respectively. Alternatively, the alignment guide  300  can be positioned such that the first and second cannulas  310  and  312  and the third and fourth cannulas  314  and  316 , and thus the first and second k-wires  252  and  256  and the third and fourth k-wire  260  and  264 , extend medially from the medial cuneiform bone  104  and the first metatarsal  108 , respectively. 
     The first and second k-wires  252  and  256  can be oriented parallel with each other, as defined by their trajectories along the respective first and second central axes  330  and  332 . Similarly, the third and fourth k-wires  260  and  264  can be oriented parallel with each other, as defined by their trajectories along the respective third and fourth central axes  334  and  336 . Each of the k-wires  350  can be driven into the respective medial cuneiform bone  104  or the first metatarsal bone  108  at respective insertion points that can be predetermined on the patient&#39;s foot. 
     Referring now to  FIGS.  14 F- 14 G , once the k-wires  252 ,  256 ,  260 , and  264  have been driven into the patient&#39;s foot, the alignment guide  300  can be removed. First, as shown at  FIG.  14 F , the insert  311  can be removed from the third and fourth k-wires  260  and  264  by moving the insert  311  away from the guide body, and thus away from the patient&#39;s foot  100 , along the k-wires  260  and  264  until the k-wires  260  and  264  have been removed from the insert  311 . Next, as shown at  FIG.  14 G , the guide body  301  can then be removed from the k-wires  252 ,  256 ,  260 , and  264  by moving the guide body  301  away from the patient&#39;s foot  100 . It should be appreciated that once the insert  311  is removed, the third and fourth k-wires  260  and  264  extend through the aperture  313 , such that clearance exists between the guide body  301  and the third and fourth k-wires  260  and  264 . In this regard, it is recognized that the first and second central axes  330  and  332  of the first and second k-wires  252  and  256  are angularly offset from the third and fourth central axes  334  and  336  of the third and fourth k-wires  260  and  264 . The guide body  301  is removed from the first and second cannulas  310  and  312  along the respective first and second central axes  330  and  332 , and aperture  313  provides the clearance that allows the second end portion  308  to be removed from the third and fourth k-wires  260  and  264 . In some examples the third and fourth k-wires can extend out the opening  315  during removal of the guide body  301  from the patient&#39;s foot. It should be appreciated that the joint alignment member  372  can be removed from the joint  369  after the proximal and distal k-wires have been driven into the patent&#39;s foot  100 . The joint alignment member  372  can be removed from the joint  369  before or after removal of the alignment guide  300 . 
     Referring now to  FIGS.  15 A- 15 B , once the alignment guide  200  or  300  has been removed, the patient&#39;s foot  100  can be aligned. In particular, the system for correcting alignment in the patient&#39;s foot  100  can include a resection guide  404 . The resection guide  404  can align a resecting tool (not shown), such as a saw, a broach, or the like, with an end of the medial cuneiform bone  104  and/or an end of the metatarsal bone  108 , respectively. 
     The resection guide  404  can include a cannulated portion  411 . The cannulated portion  411  can include one or more apertures  415 ,  417 . The resection guide  404  can include a plane portion  409 . The plane portion can include a slot  407  for aligning the resecting tool. The apertures  415 ,  417  can interact with one or more k-wires (e.g., k-wires  250 ) or pins to align the plane portion  409  with the desired target location for the resection tool. 
     The plane portion  409  (e.g., a plane defining the slot  407 ) can be generally perpendicular with the cannulated portion  411  (e.g., an axis between the apertures  415 ,  417 ). In other implementations, the plane portion  409  can be angled with respect to the cannulated portion  411 . 
     The apertures  415 ,  417  can extend through the cannulated portion  411 . The apertures  415 ,  417  can be sized to align with the k-wires or pins. The slot  407  can extend through the plane portion  409 . The slot  407  can have a height and thickness sized to accommodate the cutting portion of the resection tool. The slot  407  can have a depth sufficient to maintain alignment of the resection tool with the desired target location. 
     Depending on a planned corrected configuration of the first cuneiform bone  104  with the metatarsal  108 , it may be necessary to remove material from one or both inner ends of the cuneiform bone  104  and the metatarsal  108 . The angle between the cuneiform bone  104  and the metatarsal  108  can be adjusted in the corrected configuration. The lengths of one or both of the cuneiform bone  104  and the metatarsal  108  can also be adjusted in the corrected configuration. Each of these adjustments can contribute to the correction of the deformity in the patient&#39;s foot  100 . 
     Accordingly,  FIGS.  16 A- 16 B  show usage of the first resection guide  404  to align a resection tool with a first inner end of the first cuneiform bone  104 . The cannulated portion  411  can be received over the first and second k-wire  252 ,  256  on the apertures  415 ,  417 , respectively. This can align the plane portion (e.g., the slot  407 ) with the end of the first cuneiform bone  104 . A resection plane  104   a  can be cut into the first cuneiform bone  104  using a resecting tool through the slot  407 . The resection plane  104   a  can be aligned with the first and second k-wire  252 ,  256 . 
       FIG.  17    shows usage of a second resection guide  408  to align a resection tool with a first inner end of the metatarsal bone  108 . The second resection guide  408  can include the same components as the resection guide  404  (e.g., a plane portion  409  and a cannulated portion  411 ). 
     The cannulated portion  411  of the second resection guide  408  can be received over the third and fourth k-wires  260 ,  264  on apertures  415 ,  417 , respectively. The third and fourth k-wires can align the plane portion  409  and a slot  407  with the end of the metatarsal bone  108 . A resection plane  108   a  can be cut into the metatarsal bone  108  using a resecting tool through the slot  407 . The resection plane  108   a  can be aligned with the third and fourth k-wires  260 ,  264 . In some implementations, the resection guide  404  can be used to form the resection plane  108   a  instead of the section resection guide  408 . 
     As shown in  FIGS.  18 A- 18 B , the system for correcting alignment in the patient&#39;s foot  100  can include a correction guide  500 . The correction guide  500  can align the bones in the patient&#39;s foot  100  from the initial or deformed configuration into a corrected configuration  103  that is different than the initial or deformed configuration, as shown in  FIGS.  19 A- 19 B , and reduces the deformity that is defined by the first metatarsal  108 . In particular, the correction guide can cause the first metatarsal  108  to move from the initial configuration to the corrected configuration by rotating the first metatarsal  108  relative to the medial cuneiform  108  and/or translating the first metatarsal  108  relative to an adjacent second metatarsal  109 . The correction guide  500  can define an inner bone-facing surface  501  and an opposite outer surface  503 . The correction guide  500  can include a first end portion  504 . The correction guide  500  can include at least one proximal cannula  513  such as first and second cannulas  510  and  512  that extend through the correction guide  500 , and in particular through the first end portion  504 . The first and second cannulas  510  and  512  can correspond to the first and second k-wires  252  and  256 , respectively, which have been previously driven at least into or through the medial cuneiform bone  104 . The first and second cannulas  510  and  512  can extend along respective first and second central axes  530  and  532 , respectively. The first and second central axes  530  and  532  can be parallel to each other, or can alternatively be oriented at any suitable angle relative to each other as desired. 
     The correction guide  500  can include a second end portion  508  that extends distally with respect to the first end portion  504 . The inner and outer surfaces  501  and  503  can be defined by the first end portion  504  and the second end portion  508 . In one example, the first and portion  504  and the second end portion  508  can define a single monolithic unitary structure. Thus, the first and second end portions  504  and  508  can be positionally fixed with respect to each other. The first end portion  504  can be referred to as a proximal end portion, and the second end portion  508  can be referred to as a distal end portion. The correction guide  500  can include at least one distal cannula  515  such as third and fourth cannulas  514  and  516  that extend through the correction guide  500 , and in particular through the second end portion  508 . The third and fourth cannulas  514  and  516  can correspond to the third and fourth k-wires  260  and  264 , respectively, which have been previously driven at least into or through the metatarsal bone  108 . The third and fourth cannulas  514  and  516  can extend along respective third and fourth central axes  534  and  536 , respectively. The third and fourth central axes  534  and  536  can be parallel to each other, or can alternatively be oriented at any suitable angle relative to each other as desired. 
     The first and second cannulas  510  and  512  can be referred to as proximal cannulas  513  of the correction guide  500 , and the third and fourth cannulas  514  and  516  can be referred to as distal cannulas  515  of the correction guide that are spaced distally from the proximal cannulas  513 . The proximal k-wires  251  are configured to be driven into cuneiform bone  104  in the manner described above, and inserted into respective ones of the proximal cannulas  513 . The distal k-wires  253  are configured to be driven into the metatarsal  108  in the manner described above, and inserted into respective ones of the distal cannulas  515 . While the system can include two proximal k-wires  251  and two distal k-wires  253  in one example, it should be appreciated that the system can include any number of proximal and distal k-wires including at least one. Thus, at least one proximal k-wire  251  can be inserted through at least one proximal cannula  513  and into the cuneiform bone  104 , and at least one distal k-wire  253  can be inserted through at least one distal cannula  515  and into the metatarsal  108 . 
     The proximal and distal cannulas  513  and  515 , respectively, extend through the correction guide from the outer surface  503  to the inner surface  501 . The first cannula  510  can extend through the outer surface  503 , such that the first central axis  530  extend through a point PC. The point PC can have a position (x, y, z) in the Cartesian coordinate plane. Similarly, the fourth cannula  516  can extend through the outer surface  503 , such that the fourth central axis  536  extend through a point PD that has a respective position (x, y, z) in the Cartesian coordinate plane. The points PC and PD can define a relative position of the first and fourth central axes  530  and  536  in the Cartesian coordinate system. 
     As shown in  FIGS.  19 A- 19 B , the correction guide  500  can be received on the k-wires  250 . The at least one proximal k-wire  251  can be received within a respective at least one proximal cannula  513 , and the at least one distal k-wire  253  can be received within a respective at least one distal cannula  513 . The at least one proximal and distal k-wires  251  and  253  can be positioned in the cannulas of the correction guide  500  after having been driven into either of the alignment guides  200  and  300  and after subsequent removal of the alignment guide. It is recognized that the k-wires  251  and  253  extend medially from the medial cuneiform  104  and the first metatarsal  108  as shown in  FIGS.  19 A- 19 B . Alternatively, the k-wires  251  and  253  can extend superiorly from the medial cuneiform  104  and the first metatarsal  108  as described above. 
     The first and second central axes  530  and  532  can have a predetermined angular relationship with respect to the third and fourth central axes  534  and  536  from a view from the frontal plane. In one example shown at  FIG.  18 B , the predetermined angular relationship can be a parallel relationship, such that the first and second central axes  530  and  532  are oriented parallel with the third and fourth axis  534  and  536 . Thus, the first and second central axes  530  and  532  can be aligned within the same plane as the third and fourth central axis  534  and  536 . In other words, a common plane can include each of the first and second central axes  530  and  532  along with the third and fourth central axes  534  and  536 . Alternatively, the first and second central axes  530  and  532  can be angularly offset with respect to the third and fourth central axes  534  and  536  with respect to a view from the frontal plane. 
     The correction guide  500  can align the metatarsal bone  108  relative to the medial cuneiform bone  104  as it is advances on the k-wires  250 . In particular, the first and second proximal k-wires  252  and  256  are received by the first and second proximal cannulas  510  and  512 , respectively, and the third and fourth distal k-wires  260  and  264  are received by the third and fourth distal cannulas  514  and  516 , respectively. The first and second k-wires  252  and  256  can be oriented along the first and second central axes  530  and  532 , respectively, and the third and fourth k-wires  260  and  264  can be oriented along the third and fourth central axes  534  and  536 , respectively. The correction guide  500  thus causes the proximal k-wires to move to thereby assume the predetermined angular relationship with the distal k-wires. As the at least one distal k-wire moves relative to the at least one proximal k-wire, the at least one distal k-wire causes the first metatarsal  108  to correspondingly move with respect to the medial cuneiform bone  104  and the second metatarsal bone  109 . Thus, the correction guide  500  can cause the distal k-wires to rotate in the frontal plane, which in turn causes the metatarsal  108  to rotate in the frontal plane with respect to the cuneiform bone  104  in a direction of rotation. The direction of rotation can be in the counterclockwise direction in the frontal plane (that is, from a view of the frontal plane in the proximal direction). The correction guide  500  can therefore orient the distal k-wires  260  and  264 , and thus the metatarsal bone  108  and the proximal phalanx  112 , into the corrected configuration  103 . Re-orientation of the metatarsal  108  relative to the medial cuneiform bone  104  can include rotation and/or translation of the metatarsal  108  in the Cartesian coordinate system (e.g., in three orthogonal planes). The degree of rotation and/or translation of the metatarsal  108  can be determined based on the angles α, β, and/or γ, and/or any differences in the relative positions of the axes between the alignment guide  200  and the correction guide  500  (e.g., any differences in the relative positions defined by points A, B and points C, D). In one example, the correction guide  500  can cause the at least one distal k-wire  253  to rotate in the frontal plane, for instance in a clockwise direction with respect to a view from the frontal plane. Thus, the metatarsal  108  similarly rotates in the clockwise direction in the frontal plane. Because the first and second central axes  530  and  532  can be oriented parallel with respect to the third and fourth central axes  534  and  536 , the correction guide  500  does not compress or distract the TMT joint  369  as it receives the proximal and distal k-wires  251  and  253 . 
     The corrected configuration  103  can include one or more corrections to the alignment of the bones of the patient&#39;s foot  100 . For example, the metatarsal  108  can be generally aligned with the proximal phalanx  112  of the great toe. The corrected configuration  103  can reduce or eliminate the bunion and/or hallux valgus deformity. The resected face  104   a  of the medial cuneiform bone  104  can be abutted against the resected face  108   a  of the metatarsal bone  108 . This abutment can promote the union or fusion of the metatarsal  108  with the medial cuneiform bone  104 . Proper abutment can require translation of the metatarsal  108  relative to the medial cuneiform bone  104 . 
     Referring now to  FIG.  18 C , in another example the predetermined angular relationship between the first and second axes  530  and  532  and the third and fourth central axes  534  and  536  can be an angular offset with respect to each other. For instance, the first and second central axes  530  and  532  can converge toward the third and fourth central axes  534  and  536  as they extend in a direction from the outer surface  503  to the inner surface  501 . In particular, the first and second central axes  530  and  532  can converge toward the third and fourth central axes  534  and  536  can converge toward each other along a longitudinal direction that includes the distal direction and proximal direction that is opposite the distal direction. In one example, the first and second central axes  530  and  532  can be aligned with each other and with the third and fourth central axes  534  and  536 , for instance along the distal direction. Thus, the first and second central axes  530  and  532  can be coplanar with the third and fourth central axes  534  and  536 , such that a common plane includes each of the central axes  530 ,  532 ,  534 , and  536 . During use, the correction guide  500  can compress the TMT joint  369  as it receives the proximal and distal k-wires  251  and  253  and is driven toward the cuneiform bone  104  and the metatarsal  108 . In this regard, the correction guide  500  can be configured for a combination of realignment and compression of the cuneiform bone  104  and the metatarsal  108 , and thus can be referred to as a “realignment and compressor block” (e.g., a RAC block). 
     While the first and second k-wires  252 ,  256  can be received within the first and second cannula  510  and  512 , respectively, on the first end  504  of the correction guide  500 , and the third and fourth k-wires  260  and  264  can be received within the third and fourth cannula  514  and  516 , respectively, on the second end  508  of the correction guide  500 , it should be appreciated that any number of k-wires in the cuneiform bone  104  and the metatarsal bone  108  can be inserted through respective cannulas of the correction guide as desired. 
     As shown in  FIG.  20   , the medial cuneiform bone  104  can be fixed temporarily or permanently relative to the metatarsal  108  in the corrected configuration  103 . A first or proximal fixing k-wire  610  can be inserted into the medial cuneiform bone  104  and the metatarsal bone  108 . The first fixing wire  610  can extend through the resection faces  104   a ,  108   a . A second or distal fixing k-wire  612  can be inserted through the metatarsal  108  and into the medial cuneiform bone  104 . The second fixing k-wire  612  can be inserted through the resection planes  104   a ,  108   a . In other implementations, any temporary or permanent fixing means can be used for connecting the medial cuneiform bone  104  with the metatarsal bone  108  in the corrected configuration. For example, the medial cuneiform bone  104  and the metatarsal bone  108  can be screwed together, braced together, adhered together or otherwise connected together on a temporary or permanent basis. 
     As shown in  FIG.  21   , with the medial cuneiform bone  104  and the metatarsal bone  108  fixed in the corrected configuration  103 , the correction guide  500  can be removed from the plurality of the k-wires  250 . The plurality of k-wires  250  can be removed from the medial cuneiform bone  104  and/or the metatarsal bone  108 . 
     As shown in  FIG.  22   , the system for correcting alignment in the patient&#39;s foot  100  can include a bone plate assembly  700 . The bone plate assembly  700  attach the medial cuneiform bone  104  and the metatarsal  108 , as shown in  FIGS.  25 - 26   . The bone plate assembly  700  can include a bone plate  710 . The bone plate  710  can include a first end  704  and a second end  708 . The bone plate assembly  700  can include a bone clip  720 . The bone clip  720  can couple between the medial cuneiform bone  104  and the metatarsal bone  108 . The bone clip  720  can include a first prong  724  and second prong  728  connected by a transverse member  726 . The bone plate assembly  700  can include a plurality of fasteners  730  such as bone screws, pins or other fasteners known in the field of orthopedics. 
       FIGS.  23 - 24    show further detail of the bone plate  710 . The bone plate  710  can be contoured to fit against the medial cuneiform bone  104  and the metatarsal bone  108 . The bone plate  710  can be made out of titanium, aluminum, steel, other suitable materials in the orthopedic field. 
     The first end  704  of the bone plate  710  can have a plurality of apertures  715 ,  716 ,  717 . The apertures  716 ,  717  can be sized to receiver the fasteners  730 . The aperture  715  can be sized to receive the prong  724  of the clip  720 . The second end  708  of the bone plate  710  can have a plurality of apertures  711 ,  712 ,  713 . The apertures  711 ,  712  can be sized to receive the fasteners  730 . The aperture  713  can be sized to receive the prong  728  of the clip  720 . The clip  720  can include a recess  719  for receiving, or at least partially receiving, the transverse member  726  of the clip  720 . This can reduce the overall profile of the assembled bone plate assembly  700 . 
       FIGS.  25 - 26    show the bone plate assembly  710  assembled with the patient&#39;s foot  100 . The first end  704  of the bone plate  710  can be attached with the medial cuneiform bone  104  by the fasteners  730 . The fasteners  730  can extend through the apertures  716 ,  717  and into the medial cuneiform bone  104 . The second end  708  of the bone plate  710  can be attached with the metatarsal bone  108 . The fasteners  730  can extend through the apertures  711 ,  712  and into the metatarsal bone  108 . In some implementations, the fasteners  730  can be received within respective intersection points  254 ,  258 ,  262 , and/or  266  of the k-wires  250 . Alternatively, the fasteners can form new holes in the bones of the patient&#39;s foot. 
     The clip  720  can span across the joint between the medial cuneiform bone  104  and the metatarsal bone  108 . The first prong  724  can be received within aperture  715  and into the metatarsal bone  108 . The second prong  728  can be received through the aperture  713  and into the medial cuneiform bone  104 . In certain implementations, the prongs  724 ,  728  can be received within the respective intersections  258 ,  262 . The prongs  724 ,  728  can include a plurality of serrated edges for enhanced engagement features for attaching within the bones in the patient&#39;s foot  100 . 
     In certain implementations, different alignment guides  200  can be used depending on the intended fixation means for the medial cuneiform bone  104  with the metatarsal bone  108 . The different alignment guides  200  can include cannula that align the k-wires  250  at different points in the bone to match apertures in the different fixation means. 
     Virtual Modelling of Correction Factor 
       FIG.  27    describes a process  800  for designing an alignment guide that customized to a patient&#39;s unique anatomy. Although described herein in the context of a patient&#39;s foot, the process  800  can be used for other parts of a patient&#39;s body. The process  800  is further illustrated in  FIGS.  28 A- 28 D . At step  812 , a virtual model  840  of a patient&#39;s foot is created. The virtual model  840  can be based on a scan of a patient&#39;s foot including a deformity, such as a bunion and/or Hallux valgus. The scan used to create or render the virtual model  840  can be based on a CT, PET, X-ray, ultrasound, MRI, or other type of medical imaging scan. 
     The virtual model  840  can include virtual representations of the bones of the patient&#39;s foot. The virtual model  840  can include a virtual deformed configuration  802  of the patient&#39;s bones. The virtual model  840  can include a virtual first bone  804  and a virtual second bone  808 . The virtual first bone  804  can correspond to a medial cuneiform bone in the patient&#39;s foot and the virtual second bone  808  can correspond to a metatarsal. 
     The virtual model  840  can be displayed to a user through a graphical user interface (e.g., on a computer). The virtual model  840  can be manipulable by a user. In some implementations, the virtual model  840  can approximate the natural connections (e.g., ligaments, cartilage, and/or muscles) between bones in the patient&#39;s foot. Accordingly, movements of one virtual bone can alter the location of connected virtual bones. In other implementations, the virtual bones of the model  840  can be freely moved and manipulated by a user. Accordingly, feasible re-positioning of the bones and resultant movements of connected virtual bones can be approximated based on the skill and knowledge of a user. 
     At step  814 , a user adjusts the configuration of first and second virtual bones  804 ,  808  into a virtual corrected configuration  803 . The virtual corrected configuration  803  can include correction of one or more deformities of the patient&#39;s foot. Adjustment into the virtual corrected configuration  803  can include changing relative angles and positions between the first and second virtual bones  804 ,  808 . Moreover, the virtual corrected configuration  803  can include one or more overlapping portions of the first and second virtual bones  804 ,  808 . One or more virtual resection planes  804   a ,  808   a , can be identified by a user to remove overlapping portions of the first and second virtual bones  804 ,  808  or otherwise adjust the lengths and dimensions thereof. 
     At step  816 , a first virtual axis  830  is added to intersect the first virtual bone  804 . A second virtual axis  836  is added to intersect the second virtual bone  808 . The first virtual axis  830  is fixed relative to the first virtual bone  804 . The second virtual axis  836  is fixed relative to the second virtual bone  808 . The first and second virtual axes  830 ,  836  can be aligned with the virtual model  840  at a location that is easily accessible during surgery of the patient&#39;s foot. 
     The first and second virtual axes  830 ,  836  are parallel with each other. Advantageously, the first and second virtual axes  830 ,  836  can be aligned with one or more of the virtual resection planes  804   a ,  808   a . The first virtual axis  830  extends through a point PG located in a virtual Cartesian coordinate system. The second virtual axis  836  extends through a point PH located in the virtual Cartesian coordinate system. 
     At step  818 , the first and second virtual bones  804 ,  808  are returned to the original deformed configuration  802  of the model  840 . The first and second virtual axes  830 ,  836  are rotated to different angles and/or translated relative to each other into the deformed configuration  802  from the corrected configuration  803 . In the deformed configuration  802 , the first and second virtual axes  830 ,  836  can be defined as vectors passing through respective point PE and PF, respectively, within the virtual Cartesian coordinate system. 
     At step  820 , the relative positions of the first and second virtual axes  830 ,  836  in the deformed configuration  802  can be used to define a correction factor for an alignment guide. The relative positions can include relative angles in two or more of the virtual Cartesian coordinate system planes (e.g., z-x, z-y, x-y). The relative angles can correspond to the α, β, and/or γ angles in the alignment guide (e.g., alignment guide  200  or the like). The relative positions of the first and second virtual axes  830  and  836  can be based on the respective points PE and PF. The points PE and PF can correspond to the respective points PA and PB of the alignment guide (e.g., alignment guide  200  or the like). Thus, the dimensions of the virtual model  840  can be used to form the correction factor of an alignment guide for use in surgery on the patient&#39;s foot. 
     Furthermore, the relative positions of the first and second virtual axes  830 ,  836  in the corrected configuration  803  can be used to define dimensions of a correction guide. The points PG and PH can correspond to the respective points PC and PD of the correction guide (e.g., correction guide  500  or the like). The first and second virtual axes  830 ,  836  in the corrected configuration  803  can correspond to the parallel axes of the cannula in the correction guide. 
     Furthermore, the relative positions of the first and second virtual axes  830 ,  836  in the deformed configuration  802  can be used to define dimensions of a resection guide. The dimensions can include an orientation of a slot (e.g., slot  407 ) in the resection guide. The slot can be aligned parallel with one or more of the resection planes  804   a ,  808   a . The resection guide can also include one or more apertures aligned with the first and/or second virtual axes  830 ,  836  in the deformed configuration  802 . 
     As an alternative to creating the model  803 , a user (e.g., a surgeon) could describe the angles (α, β, and/or γ) and/or translations needed to correct the deformities in the patient&#39;s foot  100 . This description can be based on a user&#39;s knowledge and experience and/or in conjunction with viewing a scan of the patient&#39;s foot  100 . The user-provided information can indicate the alignment guide  200  needed during in surgery. For example, a user can be provided a kit with multiple alignment guides and select among a predetermined set of alignment guides  200  that each correct different, but commonly seen deformations in a patient&#39;s foot. In certain implementations, the alignment guide  200  can include multiple sets of cannula that correspond to different correction factors. 
     Manufacturing of Lapidus System 
     Referring to  FIG.  29   , process  900  is a method of manufacturing a system for correcting alignment in the patient&#39;s foot  100  based on a correction factor. At step  912 , a manufacturer can receive a correction factor. The correction factor can define one or more dimensions of an alignment guide (e.g., alignment guide  200 ). The correction factor can be a CAD model, in some implementations. The dimensions can include orientation and positioning of one or more cannula therethrough. For example, the correction factor can be based on the process  800  described above and/or user-provided information. The correction factor can be customized to an individual patient&#39;s foot. Alternatively, the correction factor can be one of a standard set of commonly used correction factors. 
     At step  914 , the manufacturer can form the alignment guide based on the correction factor. For example, the manufacture can 3D print the alignment guide. 
     At step  916 , the manufacturer can receive dimensions for creating a correction guide. The dimensions for the correction guide can be based on the process  800  described above or otherwise customized to an individual patient&#39;s foot. 
     At step  918 , the manufacturer can form the correction guide based on the received dimensions. For example, the manufacture can 3D print the correction guide. 
     It is further appreciated that in some instances the final configuration  103  (see  FIG.  19 A ) of the metatarsal  108  and/or the proximal phalanx  112  with respect to the cuneiform bone  104  as produced by the correction guide  500  may be undesirable or otherwise sub-optimal as determined during the surgical procedure. Accordingly, once the bones in the patient&#39;s foot  100  have been repositioned to the corrected configuration  103 , it may be desirable to further positionally adjust the metatarsal  108  with respect to the cuneiform bone  104  to an adjusted configuration  105  (see  FIGS.  31 B and  32 B ). 
     Alternative Component Structures 
       FIGS.  30 A- 30 B  illustrate another possible configuration for an alignment guide  1000 . The alignment guide  1000  can include the same features and functionalities of the alignment guide  200  described above, including some of the differences noted below. The alignment guide  1000  can include a first portion  1004  and a second portion  1008 . The first portion  1004  can be releasably connectable with the second portion  1008 . The first portion  1004  can include a handle  1004   a . The handle portion  1004   a  can include an aperture therethrough. The handle portion  1004   a  can function to enable a user to easily hold the alignment guide  1000  in place during use. The first portion  1004  of the alignment guide  1000  can include at least one proximal cannula  1013 , such as first and second cannulas  1010  and  1012  extending therethrough. The cannulas  1010  and  1012  can extend through the first portion  1004 . The cannulas  1010  and  1012  can extend along respective central axes  1020  and  1022 . The central axes  1020  and  1022  can be parallel to each other. The cannulas  1010  and  1012  can be referred to as first and second proximal cannulas. 
     The second portion  1008  can include at least one distal cannula  1015 , such as third and fourth cannulas  1014  and  1016 . The cannulas  1014  and  1016  can extend through the second portion  1008 . The cannulas  1014  and  1016  can extend along central axes  1024  and  1026 , respectively. The central axes  1014  and  1016  can be parallel with each other. The axes  1020  and  1022  can be nonparallel with the axes  1024  and  1026 . The cannulas  1014  and  1016  can be referred to as first and second distal cannulas, respectively, that are disposed distal of the proximal cannula  1013 . 
     The alignment guide  1000  can include a centering cannula  1009  that can receive a k-wire that extends into the TMT joint between the medial cuneiform bone  104  and the metatarsal  108 , thereby aligning a predetermined location of the alignment guide  1000  with the tarsometatarsal joint. Accordingly, the at least one proximal cannula  1013  can be aligned with the medial cuneiform bone  104 , and the at least one distal cannula  1015  can be aligned with the metatarsal  108 . The centering cannula  1009  can be disposed between the at least one proximal cannula  1013  and the at least one distal cannula  1015 . The centering cannula  1009  can be disposed in an intermediate portion that extends between the first and second portions  1004  and  1008 , or can be disposed in either of the first and second portion  1004  and  1008 . 
     As shown in  FIG.  31   , the first portion  1004  can be connectable with the second portion  1008  by an attachment mechanism  1006 . The attachment mechanism  1006  can be a thumbscrew. As a thumbscrew, the attachment mechanism  1006  can include a threaded end  1006   a . The attachment mechanism  1006  can extend through an aperture  1006   b  in the first portion  1004 . The attachment mechanism  1006  can extend through an aperture  1006   c  in the second portion  1008 . At least one of the apertures  1006   b ,  1006   c  can be internally threaded to couple with the threaded end  1006   a . Accordingly, the first and second portions  1004 ,  1008  can be coupled together by the attachment mechanism  1006 . 
     The second portion  1008  can include a recess  1008   a . The first portion  1004  can include a projection portion  1004   b . The projection portion  1004   b  can be received within the recessed portion  1008   a . The recess/protrusion arrangement can enhance the stability of the coupling between the first portion  1004  and the second portion  1008 . 
       FIGS.  32 A- 32 B  show another implementation of a resection guide  1100 . The resection guide  1100  can be structured similarly to the resection guide  404  described above, including some of the differences noted herein. The resection guide  1100  can include a first portion  1111 . The first portion  1111  can include one or more apertures  1115  and  1117  extending therethrough. The first portion  1111  can be coupled with a planar portion  1109 . The planar portion  1109  can include a slots  1107  therein. The slot  1107  can be sized to allow a resection tool to extend therethrough for resecting a bone of a patient&#39;s body (e.g., the patient&#39;s foot  100 ). In some implementations, the planar portion  1109  can include a curved shape to allow the slot  1107  to be placed closer to and/or in contact with the patient&#39;s body. This can reduce error associated with the process of resecting a bone. 
       FIG.  33    shows one method of using the alignment guide  1000  in a procedure for correcting alignment between two bones in a patient&#39;s body. The alignment guide  1000  can be used to correct alignment of a medial cuneiform bone  104  and a metatarsal bone  108  in a patient&#39;s foot  100 . The process shown in  FIGS.  33 - 38    is similar to and can include any of the steps and details described above in the process shown in  FIGS.  1 - 26   . 
     The centering cannula  1009  can align the alignment guide  1000  at the tarsometatarsal joint between the medial cuneiform bone  104  and the metatarsal  108 . A k-wire (not shown) can extend through the centering cannula  1009  and into the space between the medial cuneiform bone  104  and the metatarsal  108 . The first end  1004  of the alignment guide  1000  can be generally aligned with the medial cuneiform bone  104 . The second end  1008  of the alignment guide  1000  can be generally aligned with the metatarsal  108 . As shown further in  FIG.  34   , a plurality of temporary fixation element such as k-wires  1300  can be inserted through the respective cannula of the alignment guide  1000  and into the medial cuneiform bone  104  and the metatarsal bone  108 . At least one proximal k-wire  1301  such as first k-wire  1310  can be inserted through the cannula  1010  and into the medial cuneiform bone  104 . The at least one proximal k-wire  1301  can further include a second k-wire  1312  that can be inserted through the cannula  1012  and into the medial cuneiform bone  104 . At least one distal k-wire  1303  such as a third k-wire  1314  can be inserted through the cannula  1014  and into the metatarsal  108 . The at least one distal k-wire  1303  can further include a fourth k-wire  1316  that extends through the cannula  1016  into the metatarsal  108 . The k-wires  1300  can extend along respective axes of the cannula of the alignment guide  1000 . Accordingly, the alignment guide can define the intersection angles of the k-wires  1300 . 
     The first and second k-wires  1310  and  1312  can be referred to as first and second proximal k-wires, and the third and fourth k-wires  1314  and  1316  can be referred to as first and second distal k-wires that are disposed distal of the proximal k-wires. The proximal k-wires are configured to be inserted into respective ones of the proximal cannulas  1013  and into the cuneiform bone  104 . The distal k-wires are configured to be inserted into respective ones of the distal cannulas  1015  and into the metatarsal  108 . While the system can include two proximal k-wires and two distal k-wires in one example, it should be appreciated that the system can include any number of proximal and distal k-wires including at least one. Thus, at least one proximal k-wire  1301  can be inserted through at least one proximal cannula  1013  and into the cuneiform bone  104 , and at least one distal k-wire  1303  can be inserted through at least one distal cannula  1015  and into the metatarsal  108 . 
     As shown in  FIG.  35   , the first portion  1004  of the alignment guide  1000  can be removed from the second portion  1008 . The attachment mechanism  1006  can be removed from between the first portion  1004  and the second portion  1008 . the first portion  1004  can be removed from the K wires  1300 . The second portion  1008  can be removed from the k-wires  1300 . 
     As shown in  FIG.  36   , the resection guide  1100  can be slid over the k-wires  1300 . The planar portion  1109  can be aligned with one or both of the medial cuneiform bone  104  and/or the metatarsal  108 . A resection tool  1400  can be inserted through the slot  1107  to form resection planes  104   a , and/or  108   a  on the respective medial cuneiform bone  104  and metatarsal  108 . As described above, this can facilitate alignment of the medial cuneiform bone  104  and the metatarsal  108  in a corrected configuration  103 . 
     As shown in  FIG.  37   , a correction guide  1500  can be slid over the k-wires  1300 . The correction guide  1500  can be constructed as described with respect to the correction guide  500  of  FIGS.  18 A- 20   . The correction guide  1500  can include a plurality of cannula extending along respective central axes that can be parallel with each other or can converge toward each other as described above. The k-wires  1300  can be received in the respective cannulas of the collection guide  1500 . This can realign and adjust positions of the medial cuneiform bone  104 , metatarsal  108  and/or the proximal phalanx  112  to define the corrected configuration  103  of the patient&#39;s foot  100 . 
     In the corrected configuration  103 , a fixing k-wire  1600  (or similar mechanism) can be inserted to fix the positions of the first metatarsal  108  and the medial cuneiform bone  104 . As shown in  FIG.  38   , a bone plate assembly  1700 , similar to the bone plate assembly  700 , can be attached to the medial cuneiform bone  104  and the metatarsal  108  to maintain the relative positions of the two bones in the corrected configuration  103 . 
     Certain Terminology 
     Terms of orientation used herein, such as “top,” “bottom,” “proximal,” “distal,” “longitudinal,” “lateral,” and “end,” are used in the context of the illustrated example. However, the present disclosure should not be limited to the illustrated orientation. Indeed, other orientations are possible and are within the scope of this disclosure. Terms relating to circular shapes as used herein, such as diameter or radius, should be understood not to require perfect circular structures, but rather should be applied to any suitable structure with a cross-sectional region that can be measured from side-to-side. Terms relating to shapes generally, such as “circular,” “cylindrical,” “semi-circular,” or “semi-cylindrical” or any related or similar terms, are not required to conform strictly to the mathematical definitions of circles or cylinders or other structures, but can encompass structures that are reasonably close approximations. 
     Conditional language, such as “can,” “could,” “might,” or “may,” unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain examples include or 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 examples. 
     Conjunctive language, such as the phrase “at least one of X, Y, and Z,” unless specifically stated otherwise, is otherwise understood with the context as used in general to convey that an item, term, etc. may be either X, Y, or Z. Thus, such conjunctive language is not generally intended to imply that certain examples require the presence of at least one of X, at least one of Y, and at least one of Z. 
     The terms “approximately,” “about,” and “substantially” as used herein represent an amount close to the stated amount that still performs a desired function or achieves a desired result. For example, in some examples, as the context may dictate, the terms “approximately,” “about,” and “substantially,” may refer to an amount that is within less than or equal to 10% of the stated amount. The term “generally” as used herein represents a value, amount, or characteristic that predominantly includes or tends toward a particular value, amount, or characteristic. As an example, in certain examples, as the context may dictate, the term “generally parallel” can refer to something that departs from exactly parallel by less than or equal to 20 degrees. All ranges are inclusive of endpoints. 
     SUMMARY 
     Several illustrative examples of Lapidus procedure systems and methods have been disclosed. Although this disclosure has been described in terms of certain illustrative examples and uses, other examples and other uses, including examples and uses which do not provide all of the features and advantages set forth herein, are also within the scope of this disclosure. Components, elements, features, acts, or steps can be arranged or performed differently than described and components, elements, features, acts, or steps can be combined, merged, added, or left out in various examples. All possible combinations and subcombinations of elements and components described herein are intended to be included in this disclosure. No single feature or group of features is necessary or indispensable. 
     Certain features that are described in this disclosure in the context of separate implementations can also be implemented in combination in a single implementation. Conversely, various features that are described in the context of a single implementation also can be implemented in multiple implementations separately or in any suitable subcombination. Moreover, although features may be described above as acting in certain combinations, one or more features from a claimed combination can in some cases be excised from the combination, and the combination may be claimed as a subcombination or variation of a sub combination. 
     Any portion of any of the steps, processes, structures, and/or devices disclosed or illustrated in one example in this disclosure can be combined or used with (or instead of) any other portion of any of the steps, processes, structures, and/or devices disclosed or illustrated in a different example or flowchart. The examples described herein are not intended to be discrete and separate from each other. Combinations, variations, and some implementations of the disclosed features are within the scope of this disclosure. 
     While operations may be depicted in the drawings or described in the specification in a particular order, such operations need not be performed in the particular order shown or in sequential order, or that all operations be performed, to achieve desirable results. Other operations that are not depicted or described can be incorporated in the example methods and processes. For example, one or more additional operations can be performed before, after, simultaneously, or between any of the described operations. Additionally, the operations may be rearranged or reordered in some implementations. Also, the separation of various components in the implementations described above should not be understood as requiring such separation in all implementations, and it should be understood that the described components and systems can generally be integrated together in a single product or packaged into multiple products. Additionally, some implementations are within the scope of this disclosure. 
     Further, while illustrative examples have been described, any examples having equivalent elements, modifications, omissions, and/or combinations are also within the scope of this disclosure. Moreover, although certain aspects, advantages, and novel features are described herein, not necessarily all such advantages may be achieved in accordance with any particular example. For example, some examples within the scope of this disclosure achieve one advantage, or a group of advantages, as taught herein without necessarily achieving other advantages taught or suggested herein. Further, some examples may achieve different advantages than those taught or suggested herein. 
     Some examples have been described in connection with the accompanying drawings. The figures are drawn and/or shown to scale, but such scale should not be limiting, since dimensions and proportions other than what are shown are contemplated and are within the scope of the disclosed invention. Distances, angles, etc. are merely illustrative and do not necessarily bear an exact relationship to actual dimensions and layout of the devices illustrated. Components can be added, removed, and/or rearranged. Further, the disclosure herein of any particular feature, aspect, method, property, characteristic, quality, attribute, element, or the like in connection with various examples can be used in all other examples set forth herein. Additionally, any methods described herein may be practiced using any device suitable for performing the recited steps. 
     For purposes of summarizing the disclosure, certain aspects, advantages and features of the inventions have been described herein. Not all, or any such advantages are necessarily achieved in accordance with any particular example of the inventions disclosed herein. No aspects of this disclosure are essential or indispensable. In many examples, the devices, systems, and methods may be configured differently than illustrated in the figures or description herein. For example, various functionalities provided by the illustrated modules can be combined, rearranged, added, or deleted. In some implementations, additional or different processors or modules may perform some or all of the functionalities described with reference to the examples described and illustrated in the figures. Many implementation variations are possible. Any of the features, structures, steps, or processes disclosed in this specification can be included in any example. 
     In summary, various examples of Lapidus procedure systems and related methods have been disclosed. This disclosure extends beyond the specifically disclosed examples to other alternative examples and/or other uses of the examples, as well as to certain modifications and equivalents thereof. Moreover, this disclosure expressly contemplates that various features and aspects of the disclosed examples can be combined with, or substituted for, one another. Accordingly, the scope of this disclosure should not be limited by the particular disclosed examples described above, but should be determined only by a fair reading of the claims. 
     While the above detailed description has shown, described, and pointed out novel features as applied to illustrative embodiments, it will be understood that various omissions, substitutions, and changes in the form and details of the devices or algorithms illustrated can be made without departing from the spirit of the disclosure. As will be recognized, certain embodiments described herein can be embodied within a form that does not provide all of the features and benefits set forth herein, as some features can be used or practiced separately from others. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope.