Patent Publication Number: US-11642142-B2

Title: Osteotomy systems, devices and methods

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     This application is a continuation of U.S. application Ser. No. 15/792,730 filed Oct. 24, 2017, which claims priority benefit under 35 U.S.C. § 119(e) of U.S. provisional application Nos. 62/411,768 filed Oct. 24, 2016 and 62/531,176 filed Jul. 11, 2017, which are incorporated herein by reference in their entireties. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates generally to general surgery, orthopaedic implants used for achieving bone fusion. More specifically, but not exclusively, the present invention relates to osteotomy systems, devices, and methods for using the osteotomy systems. 
     BACKGROUND OF THE INVENTION 
     The current surgical techniques for hallux valgus deformities are designed for mild, moderate or severe deformities depending on their correction power. In general, most currently available surgical techniques only correct the deformity in the transverse and/or sagittal planes. One surgical technique for correction of hallux valgus is an osteotomy procedure. Osteotomies have had good success rates and reliability over time. The recurrence rate of the deformity depends on the preoperative deformity, as well as the postoperative sesamoid reduction quality. The recurrence rate being higher if the hallux valgus angle is greater than 37-40 degrees and if postoperatively there is an incomplete reduction of the sesamoids. Most osteotomies are performed in just one plane, generally the transverse plane. None of the current procedures correct the known malrotation that exists in all hallux valgus cases. The malrotation is one possible factor that could be a contributing source to the recurrence of an operated hallux valgus. Thus, new methods for performing osteotomies are needed to correct hallux valgus in all three planes and to reduce the recurrence rate. 
     SUMMARY OF THE INVENTION 
     Aspects of the present invention provide osteotomy systems, devices, and methods for using the osteotomy systems for fusing bones. 
     In one aspect, provided herein is an osteotomy system including an alignment device, at least one first k-wire for insertion into the alignment device, and a cut guide with at least one hole for receiving at least one second k-wire and a slot for receiving a saw blade. 
     In another aspect, provided herein is an osteotomy kit including an alignment device, a cut guide, and a position rotation device. 
     In yet another aspect, provided herein is an alignment device including a base with a top surface and a bottom surface, a shaft coupled to the top surface of the base and extending away from the base, and at least one angled opening extending through the base from the top surface to the bottom surface. 
     In still another aspect, provided herein is a cut guide including a top surface, a bottom surface opposite the top surface, a securement opening positioned at a first end of the cut guide and extending through the cut guide from the top surface to the bottom surface, at least one opening positioned at a second end of the cut guide and extending through the cut guide from a top surface to a bottom surface, and a cutting slot positioned between the first end and the second end and extending through the cut guide from a top surface to a bottom surface. 
     In another aspect, provided herein is a position rotation device including a base with a first end and a second end, wherein the base is curved from the first end to the second end, at least one angle opening extending through the base, and a shaft coupled to the top surface of the base and extending away from the base. 
     In yet another aspect, provided herein is a bone plate including a first portion, a second portion coupled to the first portion, at least one first opening positioned in the first portion, at least one second opening position in the second portion, and wherein the second portion is curved as it extends away from the first portion. 
     In another aspect, provided herein is a surgical method including inserting a first k-wire into a bone and sliding an alignment device over the first k-wire and into contact with the bone. The method also includes inserting a second k-wire through the alignment device and into the bone that corresponds to a rotation angle and removing the first k-wire and the alignment device. In addition, the method includes determining a hole in a cut guide that corresponds to an osteotomy cut angle and positioning the cut guide on the bone and inserting a third k-wire into a distal end of the cut guide. The method also includes guiding a sagittal saw through the cut guide and cutting the bone to form an osteotomy site and removing the cut guide. Further, the method includes rotating the distal end of the bone with respect to the proximal end to a desired angle of rotation and securing the rotated bone. 
     In still another aspect, provided herein is another surgical method including placing an alignment device on a bone, inserting a k-wire into the alignment device to correspond to a rotation angle, removing the alignment device, determining a hole in the cut guide that corresponds to an osteotomy cut angle, sliding the selected hole of the cut guide over the k-wire, guiding a sagittal saw through the cut guide and cutting the bone, removing the k-wire and cut guide, rotating the distal end of the bone with respect to the proximal end to a desired angle of rotation, and securing the rotated bone. 
     These, and other objects, features and advantages of this invention will become apparent from the following detailed description of the various aspects of the invention taken in conjunction with the accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
       The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate embodiments of the invention and together with the detailed description herein, serve to explain the principles of the invention. The drawings are only for purposes of illustrating preferred embodiments and are not to be construed as limiting the invention. It is emphasized that, in accordance with the standard practice in the industry, various features are not drawn to scale. In fact, the dimensions of the various features may be arbitrarily increased or reduced for clarity of discussion. The foregoing and other objects, features and advantages of the invention are apparent from the following detailed description taken in conjunction with the accompanying drawings in which: 
         FIG.  1    is a perspective view of one embodiment of an alignment device, in accordance with an aspect of the present invention; 
         FIG.  2    is a top view of the alignment device of  FIG.  1   , in accordance with an aspect of the present invention; 
         FIG.  3    is a side view of the alignment device of  FIG.  1   , in accordance with an aspect of the present invention; 
         FIG.  4    is a bottom view of the alignment device of  FIG.  1   , in accordance with an aspect of the present invention; 
         FIG.  5    is a front view of the alignment device of  FIG.  1   , in accordance with an aspect of the present invention; 
         FIG.  6    is a rear view of the alignment device of  FIG.  1   , in accordance with an aspect of the present invention; 
         FIG.  7    is a top perspective view of the alignment device of  FIG.  1   , in accordance with an aspect of the present invention; 
         FIG.  8    is a cross-sectional bottom, side perspective view of the alignment device of  FIG.  2    taken along line  8 - 8 , in accordance with an aspect of the present invention; 
         FIG.  9    is a cross-sectional top, side perspective view of the alignment device of  FIG.  2    taken along line  8 - 8 , in accordance with an aspect of the present invention; 
         FIG.  10    is a perspective view of another embodiment of an alignment device, in accordance with an aspect of the present invention; 
         FIG.  11    is a top view of the alignment device of  FIG.  10   , in accordance with an aspect of the present invention; 
         FIG.  12    is a side perspective view of the alignment device of  FIG.  10   , in accordance with an aspect of the present invention; 
         FIG.  13    is a bottom view of the alignment device of  FIG.  10   , in accordance with an aspect of the present invention; 
         FIG.  14    is a front perspective view of the alignment device of  FIG.  10   , in accordance with an aspect of the present invention; 
         FIG.  15    is a rear view of the alignment device of  FIG.  10   , in accordance with an aspect of the present invention; 
         FIG.  16    is a cross-sectional side view of the alignment device of  FIG.  11    taken along line  16 - 16 , in accordance with an aspect of the present invention; 
         FIG.  17    is a side perspective view of a cut guide, in accordance with an aspect of the present invention; 
         FIG.  18    is a top view of the cut guide of  FIG.  17   , in accordance with an aspect of the present invention; 
         FIG.  19    is a bottom perspective view of the cut guide of  FIG.  17   , in accordance with an aspect of the present invention; 
         FIG.  20    is an end perspective view of the cut guide of  FIG.  17   , in accordance with an aspect of the present invention; 
         FIG.  21    is a side view of the cut guide of  FIG.  17   , in accordance with an aspect of the present invention; 
         FIG.  22    is a top perspective view of another cut guide, in accordance with an aspect of the present invention; 
         FIG.  23    is a perspective view of a position rotation device, in accordance with an aspect of the present invention; 
         FIG.  24    is a top view of the position rotation device of  FIG.  23   , in accordance with an aspect of the present invention; 
         FIG.  25    is a side view of the position rotation device of  FIG.  23   , in accordance with an aspect of the present invention; 
         FIG.  26    is a bottom view of the position rotation device of  FIG.  23   , in accordance with an aspect of the present invention; 
         FIG.  27    is a front view of the position rotation device of  FIG.  23   , in accordance with an aspect of the present invention; 
         FIG.  28    is a rear perspective view of the position rotation device of  FIG.  23   , in accordance with an aspect of the present invention; 
         FIG.  29    is a perspective view of another position rotation device, in accordance with an aspect of the present invention; 
         FIG.  30    is a top view of the position rotation device of  FIG.  29   , in accordance with an aspect of the present invention; 
         FIG.  31    is a side view of the position rotation device of  FIG.  29   , in accordance with an aspect of the present invention; 
         FIG.  32    is a bottom view of the position rotation device of  FIG.  29   , in accordance with an aspect of the present invention; 
         FIG.  33    is a front view of the position rotation device of  FIG.  29   , in accordance with an aspect of the present invention; 
         FIG.  34    is a rear perspective view of the position rotation device of  FIG.  29   , in accordance with an aspect of the present invention; 
         FIG.  35    is a top perspective view of a first plate, in accordance with an aspect of the present invention; 
         FIG.  36    is a first side view of the plate of  FIG.  35   , in accordance with an aspect of the present invention; 
         FIG.  37    is a second side view of the plate of  FIG.  35   , in accordance with an aspect of the present invention; 
         FIG.  38    is a top view of the plate of  FIG.  35   , in accordance with an aspect of the present invention; 
         FIG.  39    is a bottom view of the plate of  FIG.  35   , in accordance with an aspect of the present invention; 
         FIG.  40    is a first end perspective view of the plate of  FIG.  35   , in accordance with an aspect of the present invention; 
         FIG.  41    is a second end perspective view of the plate of  FIG.  35   , in accordance with an aspect of the present invention; 
         FIG.  42    is a top perspective view of a second plate, in accordance with an aspect of the present invention; 
         FIG.  43    is a first side view of the plate of  FIG.  42   , in accordance with an aspect of the present invention; 
         FIG.  44    is a second side view of the plate of  FIG.  42   , in accordance with an aspect of the present invention; 
         FIG.  45    is a top view of the plate of  FIG.  42   , in accordance with an aspect of the present invention; 
         FIG.  46    is a bottom view of the plate of  FIG.  42   , in accordance with an aspect of the present invention; 
         FIG.  47    is a first end perspective view of the plate of  FIG.  42   , in accordance with an aspect of the present invention; 
         FIG.  48    is a second end perspective view of the plate of  FIG.  42   , in accordance with an aspect of the present invention; 
         FIG.  49    is a perspective view of the alignment device of  FIG.  1    positioned on a bone, in accordance with an aspect of the present invention; 
         FIG.  50    is a side view of  FIG.  49   , in accordance with an aspect of the present invention; 
         FIG.  51    is an end view of  FIG.  49    with a transparent bone, in accordance with an aspect of the present invention; 
         FIG.  52    is a perspective view of the bone and one k-wire of  FIG.  49   , in accordance with an aspect of the present invention; 
         FIG.  53    is a perspective view of the bone and k-wire of  FIG.  49    with a cut guide in a first position and a k-wire, in accordance with an aspect of the present invention; 
         FIG.  54    is a perspective view of  FIG.  53    with the cut guide in a second position, in accordance with an aspect of the present invention; 
         FIG.  55    is a perspective view of the cut guide of  FIG.  54    with a saw inserted through the cut guide and into the bone, in accordance with an aspect of the present invention; 
         FIG.  56    is an end perspective view of  FIG.  55    with a transparent bone, in accordance with an aspect of the present invention; 
         FIG.  57    is a perspective view of the bone and saw of  FIG.  56    with the saw inserted through the bone, in accordance with an aspect of the present invention; 
         FIG.  58    is a perspective view of a position rotation device positioned on the bone of  FIG.  57   , in accordance with an aspect of the present invention; 
         FIG.  59    is a perspective view of an embodiment of an alignment device, in accordance with an aspect of the present invention; 
         FIG.  60    is a top view of the alignment device of  FIG.  59   , in accordance with an aspect of the present invention; 
         FIG.  61    is a bottom view of the alignment device of  FIG.  59   , in accordance with an aspect of the present invention; 
         FIG.  62    is a side view of the alignment device of  FIG.  59   , in accordance with an aspect of the present invention; 
         FIG.  63    is a front end view of the alignment device of  FIG.  59   , in accordance with an aspect of the present invention; 
         FIG.  64    is a back end view of the alignment device of  FIG.  59   , in accordance with an aspect of the present invention; 
         FIG.  65    is a cross-sectional side view of the alignment device of  FIG.  60    taken along line  65 - 65 , in accordance with an aspect of the present invention; 
         FIG.  66    is a first side perspective view of another embodiment of a cut guide, in accordance with an aspect of the present invention; 
         FIG.  67    is a second side perspective view of the cut guide of  FIG.  66   , in accordance with an aspect of the present invention; 
         FIG.  68    is a distal end perspective view of the cut guide of  FIG.  66   , in accordance with an aspect of the present invention; 
         FIG.  69    is a top view of the cut guide of  FIG.  66   , in accordance with an aspect of the present invention; 
         FIG.  70    is a side view of the cut guide of  FIG.  66   , in accordance with an aspect of the present invention; 
         FIG.  71    is an end view of the cut guide of  FIG.  66   , in accordance with an aspect of the present invention; 
         FIG.  72    is a top perspective view of another embodiment of a position rotation device, in accordance with an aspect of the present invention; 
         FIG.  73    is a top view of the position rotation device of  FIG.  72   , in accordance with an aspect of the present invention; 
         FIG.  74    is a side view of the position rotation device of  FIG.  72   , in accordance with an aspect of the present invention; 
         FIG.  75    is a bottom view of the position rotation device of  FIG.  72   , in accordance with an aspect of the present invention; 
         FIG.  76    is a front view of the position rotation device of  FIG.  72   , in accordance with an aspect of the present invention; 
         FIG.  77    is a rear perspective view of the position rotation device of  FIG.  72   , in accordance with an aspect of the present invention; 
         FIG.  78    is a side view of an alignment guide, in accordance with an aspect of the present invention; 
         FIG.  79    is a side perspective view of the alignment guide of  FIG.  78   , in accordance with an aspect of the present invention; 
         FIG.  80    is an exploded, side perspective view of the alignment guide of  FIG.  78   , in accordance with an aspect of the present invention; 
         FIG.  81    is a top perspective view of another embodiment of a bone plate, in accordance with an aspect of the present invention; 
         FIG.  82    is a first side view of the bone plate of  FIG.  81   , in accordance with an aspect of the present invention; 
         FIG.  83    is a second side view of the bone plate of  FIG.  81   , in accordance with an aspect of the present invention; 
         FIG.  84    is a top view of the bone plate of  FIG.  81   , in accordance with an aspect of the present invention; 
         FIG.  85    is a bottom view of the bone plate of  FIG.  81   , in accordance with an aspect of the present invention; 
         FIG.  86    is a first end perspective view of the bone plate of  FIG.  81   , in accordance with an aspect of the present invention; 
         FIG.  87    is a second end perspective view of the bone plate of  FIG.  81   , in accordance with an aspect of the present invention; 
         FIG.  88    is an exploded, bottom perspective view of a portion of a foot plate guide, in accordance with an aspect of the present invention; 
         FIG.  89    is an assembled, top view of the foot plate guide of  FIG.  88   , in accordance with an aspect of the present invention; 
         FIG.  90    is an assembled, side view of the foot plate guide of  FIG.  88    with a foot positioned on the foot plate, in accordance with an aspect of the present invention; 
         FIG.  91    is a side perspective view of the foot of  FIG.  90    with the alignment device of  FIG.  59    positioned on the foot, in accordance with an aspect of the present invention; 
         FIG.  92    is a side perspective view of the foot of  FIG.  91    with the cut guide of  FIG.  66    positioned on the foot, in accordance with an aspect of the present invention; 
         FIG.  93    is a proximal end, perspective view of the foot and cut guide of  FIG.  92   , in accordance with an aspect of the present invention; 
         FIG.  94    is a side perspective view of the foot and cut guide of  FIG.  92    with a saw inserted through the cut guide, in accordance with an aspect of the present invention; 
         FIG.  95    is a side perspective view of the foot of  FIG.  94    after the cut guide is removed, in accordance with an aspect of the present invention; 
         FIG.  96    is a side perspective view of the foot of  FIG.  95    with the saw removed and the position rotation device of  FIG.  72    positioned on the foot, in accordance with an aspect of the present invention; 
         FIG.  97    is a side perspective view of the foot of  FIG.  96    with a second k-wire inserted through the position rotation device, in accordance with an aspect of the present invention; 
         FIG.  98    is a side perspective view of the foot of  FIG.  97    with the position rotation device removed, in accordance with an aspect of the present invention; 
         FIG.  99    is a side perspective view of the foot of  FIG.  98    after rotation of distal bone segment, in accordance with an aspect of the present invention; 
         FIG.  100    is a distal end view of the foot of  FIG.  99   , in accordance with an aspect of the present invention; 
         FIG.  101    is a side perspective view of the foot of  FIG.  100    with temporary fixation members inserted across the osteotomy, in accordance with an aspect of the present invention; 
         FIG.  102    is a side perspective view of the foot of  FIG.  101    after the coupled alignment guide of  FIG.  78    and the bone plate of  FIG.  81    are attached to the foot, in accordance with an aspect of the present invention; 
         FIG.  103    is a side perspective view of the foot of  FIG.  102    with the k-wire being inserted into the foot, in accordance with an aspect of the present invention; 
         FIG.  104    is a side perspective view of the foot of  FIG.  103    with the alignment guide removed from the plate, in accordance with an aspect of the present invention; 
         FIG.  105    is a side perspective view of the foot of  FIG.  104    with a compression screw inserted across the osteotomy site, in accordance with an aspect of the present invention; 
         FIG.  106    is a side perspective view of the foot of  FIG.  105    after the bone screws are inserted to secure the plate over the osteotomy site, in accordance with an aspect of the present invention; 
         FIG.  107    is a first end perspective view of another cut guide, in accordance with an aspect of the present invention; 
         FIG.  108    is a second end perspective view of the cut guide of  FIG.  107   , in accordance with an aspect of the present invention; 
         FIG.  109    is a right side view of the cut guide of  FIG.  107   , in accordance with an aspect of the present invention; 
         FIG.  110    is a left side view of the cut guide of  FIG.  107   , in accordance with an aspect of the present invention; 
         FIG.  111    is a first side perspective view of the cut guide of  FIG.  107   , in accordance with an aspect of the present invention; 
         FIG.  112    is a second side view of the cut guide of  FIG.  107   , in accordance with an aspect of the present invention; 
         FIG.  113    is a first end perspective view of the cut guide of  FIG.  107   , in accordance with an aspect of the present invention; 
         FIG.  114    is a second end perspective view of the cut guide of  FIG.  107   , in accordance with an aspect of the present invention; 
         FIG.  115    is a top perspective view of another position rotation device, in accordance with an aspect of the present invention; 
         FIG.  116    is a bottom perspective view of the position rotation device of  FIG.  115   , in accordance with an aspect of the present invention; 
         FIG.  117    is first side view of the position rotation device of  FIG.  115   , in accordance with an aspect of the present invention; 
         FIG.  118    is a second side view of the position rotation device of  FIG.  115   , in accordance with an aspect of the present invention; 
         FIG.  119    is a top view of the position rotation device of  FIG.  115   , in accordance with an aspect of the present invention; 
         FIG.  120    is a bottom view of the position rotation device of  FIG.  115   , in accordance with an aspect of the present invention; 
         FIG.  121    is a first end view of the position rotation device of  FIG.  115   , in accordance with an aspect of the present invention; 
         FIG.  122    is a second end view of the position rotation device of  FIG.  115   , in accordance with an aspect of the present invention; 
         FIG.  123    is a cross-sectional view of the position rotation device of  FIG.  115    taken along line  123 - 123  in  FIG.  119   , in accordance with an aspect of the present invention; 
         FIG.  124    is a perspective view of an embodiment of an osteotomy system, in accordance with an aspect of the present invention. 
     
    
    
     DETAILED DESCRIPTION FOR CARRYING OUT THE INVENTION 
     Generally stated, disclosed herein are osteotomy systems, kits, devices and implants. Further, a surgical method for using the osteotomy systems, kits, devices and implants are discussed. 
     In this detailed description and the following claims, the words proximal, distal, anterior, posterior, medial, lateral, superior and inferior are defined by their standard usage for indicating a particular part of a bone or implant according to the relative disposition of the natural bone or directional terms of reference. For example, “proximal” means the portion of a device or implant nearest the torso, while “distal” indicates the portion of the device or implant farthest from the torso. As for directional terms, “anterior” is a direction towards the front side of the body, “posterior” means a direction towards the back side of the body, “medial” means towards the midline of the body, “lateral” is a direction towards the sides or away from the midline of the body, “superior” means a direction above and “inferior” means a direction below another object or structure. 
     Similarly, positions or directions may be used herein with reference to anatomical structures or surfaces. For example, as the current devices and methods are described herein with reference to use with the bones of the foot, the bones of the foot, ankle and lower leg may be used to describe the surfaces, positions, directions or orientations of the devices, instrumentation and methods. Further, the devices and methods, and the aspects, components, features and the like thereof, disclosed herein are described with respect to one side of the body for brevity purposes. However, as the human body is relatively symmetrical or mirrored about a line of symmetry (midline), it is hereby expressly contemplated that the device and methods, and the aspects, components, features and the like thereof, described and/or illustrated herein may be changed, varied, modified, reconfigured or otherwise altered for use or association with another side of the body for a same or similar purpose without departing from the spirit and scope of the invention. For example, the devices and methods, and the aspects, components, features and the like thereof, described herein with respect to a right foot may be mirrored so that they likewise function with a left foot and vice versa. Further, the devices and methods, and the aspects, components, features and the like thereof, disclosed herein are described with respect to the foot for brevity purposes, but it should be understood that the devices and methods may be used with other bones of the body having similar structures, for example the upper extremity, and more specifically, with the bones of the wrist, hand, and arm. 
     Referring to the drawings, wherein like reference numerals are used to indicate like or analogous components throughout the several views, and with particular reference to  FIGS.  1 - 48   , there are illustrated the devices of the osteotomy systems. In addition, the devices of the osteotomy systems are shown in use on a bone in  FIGS.  49 - 58   . One embodiment of an osteotomy system may include, for example, an alignment device  100 ,  150 , a cut guide  200 , a position rotating device  300 ,  350 , k-wires or fixation devices  410 ,  412 , a k-wire or fixation device  420 , an electric oscillating microsagittal saw or saw blade  430 , and a plate  500 ,  550 . 
     The alignment device  100  is shown in  FIGS.  1 - 9   . The alignment device  100  may include a base  110 , a shaft  130  coupled to the base  110 , and a handle  140  coupled to the shaft  130 . The base  110  may include a top surface  112  and a bottom surface  114 . As best seen in  FIG.  5 - 7   , the bottom surface  114  includes a first portion  116  with a first curvature, a second portion  118  with a second curvature, and a transition zone  120  with a third curvature. The first portion  116  is positioned at a first angle with respect to the transition zone  120  and the second portion  118  is positioned at a second angle with respect to the transition zone  120 . For example, in the depicted embodiment, the first angle is greater than the second angle. As shown in  FIG.  4   , the first portion  116 , second portion  118  and transition zone  120  may only be inset into a portion of the base  110  leaving sidewall portions along at least a portion of the length of the base  110 . 
     As shown in  FIGS.  1 ,  2 ,  4 , and  7 - 9   , the base  110  may also include a zero opening  122  positioned near the shaft  130 . A first angled opening  124  positioned between the zero opening  122  and the proximal end of the base  110 . A second angled opening  126  positioned near the distal end of the base  110 . A third angled opening  128  positioned between the zero opening  122  and the second angled opening  126 . A fourth angled opening  129  positioned between the zero opening  122  and the third angled opening  128 . The openings  122 ,  124 ,  126 ,  128 ,  129  may each be positioned at a specific rotation angle as it passes through the base  110  from a top surface  112  to a bottom surface  114 . For example, the zero opening  122  may have an angle of 0° for positioning and aligning the alignment device  100 . The first angled opening  124  may be angled, for example, 7.5° and may have a rotation angle of, for example, 15°. The second angled opening  126  may be angled, for example, 15° and may have a rotation angle of, for example, 30°. The third angled opening  128  may be angled, for example, 22.5° and may have a rotation angle of, for example, 45°. The fourth angled opening  129  may be angled, for example, 30° and may have a rotation angle of, for example, 60°. As illustrated in the depicted embodiment of  FIGS.  1 - 9   , the openings  122 ,  124 ,  126 ,  128 ,  129  may be positioned linearly along the top surface  112  of the base  110 . The openings  122 ,  124 ,  126 ,  128 ,  129  may be positioned in any 2D layout to ensure that the plantar portion of the osteotomy terminates a certain distance from the joint line, for example, approximately 10 mm. 
     With continued reference to  FIGS.  1 - 9   , the shaft  130  includes a first end  132  coupled to the base  110  and a second end  134  coupled to the handle  140 . The shaft  130  may include a first segment  136  near the first end  132  and a second segment  138  near the second end  134 . The first segment  136  may be angled relative to the second segment  138 . The shaft  130  may be positioned offset to one side of the top surface  112  and between a center and proximal end of the base  110 . 
     Referring now to  FIGS.  10 - 16   , another embodiment of an alignment device  150  is shown. The alignment device  150  may include a base  152 , a shaft  130  coupled to the proximal end of the base  152 , and a handle  140  coupled to the shaft  130 . The shaft  130  is as described above with reference to  FIGS.  1 - 9    and will not be described again here for brevity sake. The base  152  may include a top surface  112  and a bottom surface  114 . As best seen in  FIG.  13 - 15   , the bottom surface  114  includes a first portion  116  with a first curvature, a second portion  118  with a second curvature, and a transition zone  120  with a third curvature. The first portion  116  is positioned at a first angle with respect to the transition zone  120  and the second portion  118  is positioned at a second angle with respect to the transition zone  120 . For example, in the depicted embodiment, the first angle is greater than the second angle. As shown in  FIG.  13   , the first portion  116 , second portion  118  and transition zone  120  may only be inset into a portion of the base  110  leaving sidewall portions along at least a portion of the length of the base  110 . 
     As shown in  FIGS.  10 ,  11  and  13   , the base  152  may also include openings  122 ,  124 ,  126 ,  128 ,  129 . The openings  122 ,  124 ,  126 ,  128 ,  129  may be positioned extending through the base  152  from a top surface  112  through the bottom surface  114 . The zero opening  122  may be positioned near the shaft  130 . The first angled opening  124  positioned near the distal end of the base  152 . The second angled opening  126  positioned between the first angled opening  124  the third angled opening  128  and offset from the first and third angled openings  124 ,  128 . The third angled opening  128  positioned between the second angled opening  126  and the fourth angled opening  129 . The fourth angled opening  129  positioned between the zero opening  122  and the third angled opening  128  and offset from the zero opening  122  and the third angled opening  128 . The openings  122 ,  124 ,  126 ,  128 ,  129  may each be positioned at a specific rotation angle as it passes through the base  152  from a top surface  112  to a bottom surface  114 . For example, the zero opening  122  may have an angle of 0° for positioning and aligning the alignment device  150 . The first angled opening  124  may have a rotation angle of, for example, 15°. The second angled opening  126  may have a rotation angle of, for example, 30°. The third angled opening  128  may have a rotation angle of, for example, 45°. The fourth angled opening  129  may have a rotation angle of, for example, 60°. As illustrated in the depicted embodiment of  FIGS.  10 - 16   , the openings  122 ,  124 ,  126 ,  128 ,  129  may be positioned offset or staggered from the adjacent openings  122 ,  124 ,  126 ,  128 ,  129  along the top surface  112  of the base  152 . Alternative positions for the openings  122 ,  124 ,  126 ,  128 ,  129  are also contemplated to allow for each opening  122 ,  124 ,  126 ,  128 ,  129  to be positioned at a desired angle with respect to the base  152  and to not intersect with any other opening  122 ,  124 ,  126 ,  128 ,  129 . The openings  122 ,  124 ,  126 ,  128 ,  129  may be positioned in any 2D layout to ensure that the plantar portion of the osteotomy terminates a certain distance from the joint line, for example, approximately 10 mm. 
     Referring to  FIGS.  17 - 22   , the cut guide  200  is shown. The cut guide  200  includes a first end  202  and a second end  204 . The cut guide  200  may also include a first side  206  and a second side  208  extending from the first end  202  to the second end  204 . The cut guide  200  may have, for example, a relatively triangular shape with a point at the first end  202  and the second end  204 , the first side  206 , and the second side  208  making up the three sides of the triangle. The second end  204  may be curved between the first and second sides  206 ,  208 . The cut guide  200  may also include a top surface  210  and a bottom surface  212 . In addition, the cut guide  200  may include a transition zone  214 ,  216  positioned between the first end  202  and the second end  204 . 
     As shown in  FIGS.  19 - 21   , the first end  202  of the cut guide  200  may have a thickness between the top and bottom surfaces  210 ,  212  that is less than the thickness at the second end  204  between the top and bottom surfaces  210 ,  212 . The first transition zone  214  may be angled on the top surface  210  between the first end  202  and the second end  204 . The second transition zone  216  may be angled on the bottom surface  212  between the first end and the second end  204 . The transition zone  214 ,  216  may be angled with respect to the second end  204 . 
     With continued reference to  FIGS.  17 - 21   , the cut guide  200  may also include a securement member  218  positioned near the first end  202  of the cut guide  200 . The securement member  218  may also include an opening  220  extending through the securement member  218  from the top surface  210  through the bottom surface  212 . The cut guide  200  may further include a first window  222  positioned near the first end  202  and a second window  224  positioned near the second end  204 . The windows  222 ,  224  may extend through the cut guide  200  from the top surface  210  to the bottom surface  212 . The first and second windows  222 ,  224  may be positioned and sized to provide visualization of the bone. The first window  222  may be positioned, for example, between the securement member  218  and the transition zone  214 ,  216 . The second window  224  may be positioned, for example, between the transition zone  214 ,  216  and the second end  204 . In addition, the cut guide  200  may include at least one cutting slot  226  extending between the first side  206  and the second side  208 . The at least one cutting slot  226  may be positioned, for example, adjacent and parallel to the transition zone  214 ,  216 . In one embodiment, the cut guide  200  may include multiple cutting slots  226  positioned next to each other on and generally adjacent to the second end  204  of the cut guide  200 . 
     The cutting guide  200  may further include a first opening  228  and a plurality of second openings  230  positioned along the second end  204 , as shown in  FIGS.  17 - 22   . The second openings  230  may be, for example, positioned linearly along the curvature of the second end  204 . The openings  228 ,  230  may be sized to receive a k-wire  410 ,  412 . Referring now to  FIG.  22   , the first opening  228  may be, for example, a 0° opening, and the plurality of second openings  230  may have angles ranging from, for example, approximately 13° to 55°. In the depicted embodiment, the plurality of second openings  230  include angles of, for example, approximately 13°, 18°, 23°, 28°, 33°, 38°, 47°, and 55°. 
     Referring now to  FIGS.  23 - 28   , a position rotation device  300  is shown. The rotation device  300  includes a base  302  with a top surface  304 , a bottom surface  306  opposite the top surface  304 , a first end  308 , and a second end  310 . The base  302  may be, for example, curved to form a semi-circle. The base  302  may be angled along a side from the first end  308  to a center position of the base  302  and from the second end  310  to the center position forming a point inset into the base  302  at the center. The base  302  may also include a plurality of angle markings  312  positioned along a side of the base  302 . The base  302  may also include an opening  354  positioned adjacent to the shaft  320 . The opening  354  may be sized to receive a k-wire or fastener to secure the position rotation device  300  to a bone. The shaft  320  may include a first end  322  and a second end  324 . The first end  322  may be coupled to the top surface  304  of the base  302  near a center point. The second end  324  may be coupled to a handle  330 . The shaft  320  may include a first segment  326  near the first end  322  and a second segment  328  near the second end  324 . The first segment  326  may be angled relative to the second segment  328 . 
     Another position rotation device  350  is shown in  FIGS.  29 - 34   . The rotation device  300  includes a base  352  with a top surface  304 , a bottom surface  306  opposite the top surface  304 , a first end  308 , and a second end  310 . The base  352  may be, for example, curved to form a semi-circle. The base  352  may also include a plurality of angle markings  312  positioned along a side of the base  302 . The side of the base  352  with the plurality of angle markings  312  may be straight from the first end  308  to the second end  310 . The shaft  320  may include a first end  322  and a second end  324 . The first end  322  may be coupled to the top surface  304  of the base  302  near a center point. The second end  324  may be coupled to a handle  330 . The shaft  320  may include a first segment  326  near the first end  322  and a second segment  328  near the second end  324 . The first segment  326  may be angled relative to the second segment  328 . 
     Referring now to  FIGS.  35 - 41   , a first plate  500  is shown. The first plate  500  may include a first end  502  and a second end  504  opposite the first end  502 . The first plate  500  may also include a first portion  506  extending from a first end  502 . The plate  500  may further include a second portion  508  extending away from the first portion  506  at an angle toward the second end  504 . The plate may include a top surface  520  and bottom surface  522 . The first portion  506  may include at least one first opening  510 . The at least one first opening  510  may extend from a top surface  520  to a bottom surface  522 . The at least one first opening  510  may include a threaded portion on the interior surface of the opening  510 . The threaded portion may have, for example, at least one scallop or cutout forming a break in the threads of the threaded portion. The threaded portion may be, for example, a screw hole for receiving a fastener or screw. The threaded portion and at least one cutout are shaped to lock the fastener or screw in the opening  510 . The at least one first opening  510  may be tapered from the top surface  520  to the bottom surface  522  of the plate  500 . Although only two first openings  510  are shown in the depicted embodiment, it is also contemplated that the first portion  506  may include, for example, more than two first openings  510  to provide for additional fastening locations to secure the first portion  506  of the plate  500  to a patient&#39;s bones. 
     With continued reference to  FIGS.  35 - 41   , the second portion  508  may include at least one second opening  512 . The at least one second opening  512  may extend through the plate  500  from a top surface  520  to a bottom surface  522 . The second opening  512  may include a threaded portion on the interior surface of the opening  512 . The threaded portion may have, for example, at least one scallop or cutout forming a break in the threads of the threaded portion. The threaded portion and at least one cutout may be, for example, a screw hole for receiving a fastener or screw. The threaded portion and at least one cutout are shaped to lock the fastener or screw in the opening  512 . The at least one second opening  512  may be tapered from the top surface  520  to the bottom surface  520  of the plate  500 . Although only two second openings  512  are shown in the depicted embodiment, it is also contemplated that the second portion  508  may include, for example, more than two second openings  512  to provide for additional fastening locations to secure the second portion  508  of the plate  500  to the patient&#39;s bones. 
     The first plate  500  may also include a first alignment opening  514  and a second alignment opening  516 , as shown in  FIGS.  35 - 41   . Each opening  514 ,  516  may be sized and shaped to receive a corresponding alignment protrusion (not shown) from a plate alignment device (not shown). For example, the opening  514  may be threaded to receive a threaded peg of the alignment device (not shown). The plate  500  may further include an alignment slot  518  which may be sized and shaped to receive a temporary fixation device (not shown) or a bone compression device (not shown). The alignment openings  514 ,  516  and alignment slot  518  may be positioned near a midpoint of the first portion  506  of the plate  500 . As shown in  FIGS.  36 ,  37 ,  40  and  41   , the second portion  508  of the plate  500  may be curved as it extends away from the first portion  506 . For example, the second portion  508  of the plate may be curved to match the base of the first metatarsal and the first portion  506  of the plate  500  may be curved to match the shaft of the first metatarsal. The second end  504  may be in an offset plane from the first end  502  of plate  500  such that the plate  500  matches the anatomic contour of the first metatarsal. Further, the bottom surface  522  of the plate  500  may be curved to correspond to the shape of a corrected bone. 
     A second plate  550  is shown in  FIGS.  42 - 48   . The second plate  550  may include a first end  502  and a second end  504  opposite the first end  502 . The second plate  550  may also include a first portion  506  extending from the first end  502 . The second plate  550  may further include a second portion  508  extending away from the first portion  506  at an angle toward the second end  504 . The second plate  550  may include a top surface  520  and bottom surface  522 . The first portion  506  may include at least one first opening  510 . The at least one first opening  510  may extend through the plate  550  from a top surface  520  to a bottom surface  522 . The at least one first opening  510  may include a threaded portion on the interior surface of the opening  510 . The threaded portion may have, for example, at least one scallop or cutout forming a break in the threads of the threaded portion. The threaded portion may be, for example, a screw hole for receiving a fastener or screw. The threaded portion and at least one cutout are shaped to lock the fastener or screw in the opening  510 . The at least one first opening  510  may be tapered from the top surface  520  to the bottom surface  522  of the plate  550 . Although only two first openings  510  are shown in the depicted embodiment, it is also contemplated that the first portion  506  may include, for example, more than two first openings  510  to provide for additional fastening locations to secure the first portion  506  of plate  550  to a patient&#39;s bones. 
     With continued reference to  FIGS.  42 - 48   , the second portion  508  may include at least one second opening  512 . The at least one second opening  512  may extend through the plate  550  from a top surface  520  to a bottom surface  522 . The second opening  512  may include a threaded portion on the interior surface of the opening  512 . The threaded portion may have, for example, at least one scallop or cutout forming a break in the threads of the threaded portion. The threaded portion may be, for example, a screw hole for receiving a fastener or screw. The threaded portion and at least one cutout are shaped to lock the fastener or screw in the opening  512 . The at least one second opening  512  may be tapered from the top surface  520  to the bottom surface  522  of the plate  550 . Although only two second openings  512  are shown in the depicted embodiment, it is also contemplated that the second portion  508  may include, for example, more than two second openings  512  to provide for additional fastening locations to secure the second portion  508  of plate  550  to a patient&#39;s bones. 
     The second plate  550  may also include a first alignment opening  514  and a second alignment opening  516 , as shown in  FIGS.  42 - 48   . Each opening  514 ,  516  may be sized and shaped to receive a corresponding alignment protrusion (not shown) from a plate alignment device (not shown). For example, the opening  514  may be threaded to receive a threaded peg of the alignment device (not shown). The second plate  550  may further include an alignment slot  518  which may be sized and shaped to receive a temporary fixation device (not shown) or a bone compression device (not shown). The alignment openings  514 ,  516  and alignment slot  518  may be positioned near a midpoint of the first portion  506  of the second plate  550 . As shown in  FIGS.  43 ,  44 ,  47  and  48   , the second portion  508  of the second plate  550  may be curved as it extends away from the first portion  506 . For example, the second portion  508  of the plate may be curved to match the base of the first metatarsal and the first portion  506  of the plate  550  may be curved to match the shaft of the first metatarsal. The second end  504  may be in an offset plane from the first end  502  of plate  550  such that plate  550  matches the anatomic contour of the first metatarsal. Further, the bottom surface  522  of the second plate  550  may be curved to correspond to the shape of a corrected bone. The first plate  500  may be longer than the second plate  550 . 
     Although only two plates  500 ,  550  are shown, it is contemplated that the plates  500 ,  550  may be available in varying lengths to correspond to the varying angles of the osteotomy and the vertical inclination angles. As would be understood by one of ordinary skill in the art, as the vertical inclination angle increases, the cut will correspondingly be longer, thus needing a longer plate  500 ,  550  for proper placement along the bones. As the size of the plate  500 ,  550  increases, the positions of the openings  510 ,  512 , alignment openings  514 ,  516 , and alignment slot  518  may vary to correctly position the alignment device  900  on the plate  500 ,  550  and the openings  510 ,  512  on the bone portions. 
     A surgical method using the osteotomy system is shown in  FIGS.  49 - 58   . The method may include exposing the bone with a deformity and placing the alignment device onto the bone. The method may also include inserting a first k-wire into a first opening in the alignment device and determining the rotation angle for the bone. In addition, the method may include selecting a second opening in the alignment device that corresponds to the rotation angle and inserting a second k-wire into the second opening in the alignment device. The method may further include removing the alignment device and the first k-wire and obtaining a cut guide. The method may also include determining the hole in the cut guide that corresponds to the osteotomy cut angle and sliding the selected hole of the cut guide over the second k-wire. The method may include fixing the cut guide to the bone along the axis of the bone with a k-wire or fixation device and obtaining a sagittal saw blade. Further, the method may include inserting the saw blade through a slot in the cut guide to cut the bone and removing the securement k-wire, second k-wire and cut guide. The method may also include completing a cut of the bone and obtaining a rotation device. In addition, the method may include positioning the rotation device on the cut bone and rotating the distal end of the bone with respect to the proximal end to the desired angle of rotation on the rotation device. Optionally, the second k-wire may be left in the patient&#39;s bone, the rotation device may be slid onto the second k-wire to assist with the rotation of the distal end of the bone, and then the second k-wire may be removed. Finally, the method may include securing rotated bone with a plate and/or cross screw and closing the patient&#39;s incision. 
     The surgical method is a proximal rotational metatarsal osteotomy performed through a proximal metatarsal oblique plane osteotomy correcting the deformity through rotation. The surgical method may correct a metatarsal internal rotation and the hallux valgus deformity by rotating the metatarsal through an oblique plane with no bone resection. The surgical procedure may be performed with no loss of metatarsal length and a broader bone surface contact exists than on a transverse proximal osteotomy. The surgical procedure also may allow for correcting a transverse plane deformity by locating the metatarsal parallel to the second metatarsal and correcting an axial plane deformity, i.e. malrotation, to position the bone on top of the sesamoids. The surgical method performs a complete transverse and coronal plane deformity correction. 
     The hallux valgus surgery is performed to relocate the first metatarsal  400  above the sesamoids. First, the intermetatarsal angle is measured to evaluate the severity of the deformity on an anterior-posterior foot x-ray. The intermetatarsal angle is obtained by measuring the divergence between the first and second metatarsals. Next, the angle to be corrected is measured to determine the degrees necessary to place the metatarsal head over the sesamoid complex. There may be a limited capacity to evaluate the metatarsal malrotation, due to sesamoid subluxation. In one embodiment, axial sesamoid x-rays can give a rough estimate of first ray malrotation. In another embodiment, a preoperative CT scan is performed, which could assess metatarsal rotation and sesamoid subluxation. In another embodiment, the metatarsal rotation angle may be assessed by measuring the angle between the floor and hallux with a goniometer. 
     Once the intermetatarsal angle and rotation angle are determined, then the angle of correction or osteotomy cut angle may be determined. The rotational orientation of the osteotomy or rotation angle may be determined using the following formula: Rotation Angle=R/2. The intermetatarsal angle is represented by “A”. The angle of correction may be determined using, for example, the following formula: Osteotomy Cut Angle=arctan[sin (A/2)/tan (R/2)]. For example, a 30 degree great toe internal rotation with a 15 degree intermetatarsal angle may be corrected to 15 degrees of varus angulation to leave both metatarsals parallel and 30 degrees of internal rotation. In order to avoid having to perform calculations during surgery, the angle of correction or osteotomy cut angle may be determined using Table 1 or Table 2 below. Table 1 and Table 2 include commonly seen values for rotation angle and common intermetatarsal angles. In addition, Table 1 includes the actual osteotomy cut angles calculated using the above formulas. In another embodiment, the angle of correction may be determined using the following formula: Osteotomy Cut Angle or Vertical Inclination Angle=arctan[sin (A/2)/tan (R/2)]+α. The value of α may be, for example, approximately −10° to 25° and more specifically, −8° to 21°. The value α accounts for rounding of the vertical inclination angles to provide a reasonable number of corresponding openings in the alignment devices. An example of this alternative formula is shown in Table 2, which further simplifies Table 1 by grouping similar values together to reduce the number of openings  230  required in the cut guide  200 . Therefore, it is also contemplated that in alternative embodiments the osteotomy cut angles listed in Table 2 may be different based on an alternative grouping of osteotomy cut angles. If there is a remaining interphalangeal deformity, then an optional phalangeal osteotomy, for example, an Akin osteotomy, may be performed. 
     
       
         
           
               
               
               
             
               
                   
                 TABLE 1 
               
             
            
               
                   
                   
               
               
                   
                 Rotation Angle 
                   
               
            
           
           
               
               
               
               
               
            
               
                   
                 15° 
                 30° 
                 45° 
                 60° 
               
               
                   
                   
               
            
           
           
               
               
               
               
               
               
               
            
               
                   
                 Intermetatarsal Angle 
                 12° 
                 38 
                 21 
                 14 
                   
               
               
                   
                   
                 15° 
                 45 
                 26 
                 17 
                 13 
               
               
                   
                   
                 17° 
                 48 
                 29 
                 20 
                 14 
               
               
                   
                   
                 20° 
                 53 
                 33 
                 23 
                 17 
               
               
                   
                   
                 25° 
                 59 
                 39 
                 28 
                 21 
               
               
                   
                   
               
            
           
         
       
     
     
       
         
           
               
               
               
             
               
                   
                 TABLE 2 
               
             
            
               
                   
                   
               
               
                   
                 Rotation Angle 
                   
               
            
           
           
               
               
               
               
               
            
               
                   
                 15° 
                 30° 
                 45° 
                 60° 
               
               
                   
                   
               
            
           
           
               
               
               
               
               
               
               
            
               
                   
                 Intermetatarsal Angle 
                 12° 
                 38 
                 23 
                 13 
                   
               
               
                   
                   
                 15° 
                 47 
                 28 
                 18 
                 13 
               
               
                   
                   
                 17° 
                 47 
                 28 
                 18 
                 13 
               
               
                   
                   
                 20° 
                 55 
                 33 
                 23 
                 18 
               
               
                   
                   
                 25° 
                 55 
                 38 
                 28 
                 23 
               
               
                   
                   
               
            
           
         
       
     
     In another embodiment as shown in Table 3, the angle of correction may be determined using the following formula: Osteotomy Cut Angle or Vertical Inclination Angle=arctan[sin (A/2)/tan (R/2)]. The formula of Table 3 may be calculated using an average value for each range of intermetatarsal angles and an average value for each range of rotation angles. The values of Table 3 may be rounded up only to the nearest whole number to obtain the osteotomy cut angle or vertical inclination angle. In yet another embodiment as shown in Table 4, the angle of correction may be determined using the following formula: Osteotomy Cut Angle or Vertical Inclination Angle=arctan[sin (A/2)/tan (R/2)]+β. The value of β may be, for example, approximately −20° to 15° and, more specifically −16° to 9°. The value β accounts for an additional factor to be added to provide a reasonable number of corresponding openings in the alignment device. In order to avoid having to perform calculations during surgery, the angle of correction or osteotomy cut angle may be determined using, for example, Table 3 or Table 4 below. If there is a remaining interphalangeal deformity then an optional phalangeal osteotomy, for example, an Akin osteotomy, may be performed. 
     
       
         
           
               
               
             
               
                   
                 TABLE 3 
               
             
            
               
                   
                   
               
               
                   
                 Rotation Angle 
               
            
           
           
               
               
               
               
               
            
               
                   
                 10-19° 
                 20-29° 
                 30-39° 
                 40-50° 
               
               
                   
                   
               
            
           
           
               
               
               
               
               
               
            
               
                 Intermetatarsal Angle 
                  8-10° 
                 31 
                 19 
                 14 
                 11 
               
               
                   
                 11-12° 
                 38 
                 25 
                 18 
                 14 
               
               
                   
                 13-14° 
                 43 
                 29 
                 21 
                 16 
               
               
                   
                 15-17° 
                 47 
                 32 
                 24 
                 19 
               
               
                   
                 18-20° 
                 51 
                 37 
                 28 
                 22 
               
               
                   
               
            
           
         
       
     
     
       
         
           
               
               
             
               
                   
                 TABLE 4 
               
             
            
               
                   
                   
               
               
                   
                 Rotation Angle 
               
            
           
           
               
               
               
               
               
            
               
                   
                 10-19° 
                 20-29° 
                 30-39° 
                 40-50° 
               
               
                   
                   
               
            
           
           
               
               
               
               
               
               
            
               
                 Intermetatarsal Angle 
                  8-10° 
                 31 
                 19 
                 15 
                 15 
               
               
                   
                 11-12° 
                 39 
                 27 
                 19 
                 15 
               
               
                   
                 13-14° 
                 43 
                 31 
                 23 
                 15 
               
               
                   
                 15-17° 
                 47 
                 31 
                 23 
                 23 
               
               
                   
                 18-20° 
                 47 
                 39 
                 27 
                 23 
               
               
                   
               
            
           
         
       
     
     Once the correction is determined, a transarticular capsulotomy through a medial approach may be performed. After the proximal metatarsal is exposed, a medial mid-axis line  406  may be drawn on the bone  400  using an electrocautery or marking pen, as shown in  FIGS.  49  and  50   . The first opening  122  of the alignment device  100  may be positioned over the mid-axis line  406  on the bone  400 . As shown in  FIGS.  49  and  50   , the first k-wire  410  may then be inserted through the first opening  122  in the alignment device  100  into the bone  400 . The angle of insertion of the first k-wire  410  may be, for example, dorsal-distal to plantar-proximal, as shown in  FIG.  51   . In another embodiment, the angle of insertion of the first k-wire  410  may be, for example, parallel to the floor and perpendicular to the midline of the bone. Based on the determined angle of correction, a second k-wire  412  may be inserted into the opening  124 ,  126 ,  128 ,  129  that corresponds to half the rotation angle from Table 1, as shown in  FIGS.  49  and  50   . In the depicted embodiment, the second k-wire  412  is inserted into the fourth angled opening  129 . The angle of insertion of the second k-wire  412  may be, for example, medial to lateral, as shown in  FIG.  51   . 
     Next, as shown in  FIG.  52   , the alignment device  100  and first k-wire  410  may be removed from the bone  400 . The second k-wire  412  remains in the bone  400 . As shown in  FIG.  53   , the cut guide  200  may then be inserted over the second k-wire  412  by, for example, sliding the zero opening  228  of the cut guide  200  onto the second k-wire  412 . Once the cut guide  200  is positioned on the bone  400 , the opening  220  at the first end  202  may be aligned with the mid-axis line  406 . When the cut guide  200  is positioned the slot  226  should be generally perpendicular to the mid-axis line  406 . Next, a securement k-wire  420  may be inserted into the opening  220 , as shown in  FIG.  53   . 
     After the securement k-wire  420  is positioned, the cut guide  200  may be removed and replaced along the desired osteotomy cut angle, as shown in  FIG.  54   . The plurality of openings  230  may correspond to the varying osteotomy cut angles, for example, as shown in  FIG.  22   . Once the osteotomy cut angle is selected, the second k-wire  412  may be inserted into the selected one of the plurality of openings  230  that corresponds to the selected angle of correction or osteotomy cut angle. Once the cut guide  200  is positioned on the bone  400  at the desired correction angle, a saw  430 , for example, a microsagittal saw, may be inserted into the cutting slot  226  of the cut guide  200 , as shown in  FIGS.  55  and  56   . The bone  400  may then be cut by the saw  430  to form a first bone segment  402  and a second bone segment  404 . If necessary, the k-wire  412  and securement k-wire  420  may be bent for access to the bone  400 . As shown in  FIG.  57   , the cut of the bone  400  may be completed after removal of the cut guide  200  and optionally the k-wire  412  and securement k-wire  420 . 
     Once the osteotomy is performed and the bone  400  is separated into a first bone segment  402  and a second bone segment  404 , an instrument, for example, a field clamp or backhaus, may be used to grab the distal loose end  402  of the bone  400 . Alternatively, if the k-wire  412  is left in the bone  400  the k-wire  412  may be used to grab the distal loose end  402 . The position rotation device  300  may then be positioned on the bone  400 , as shown in  FIG.  58   . If the k-wire  412  remains in the bone  400 , then the opening  354  of the position rotation device  300  may be slid over the k-wire  412  to position the device  300 . After the rotation device  300  is on the bone  400 , the first bone segment  402  or distal end  402  of bone  400  may be rotated to the identified malrotation angle as indicated by the selected angle marking  312 . Next, a k-wire (not shown) may be inserted perpendicularly through the osteotomy, as perpendicular as possible, for transient fixation. Another k-wire (not shown) may be inserted through the osteotomy to improve the temporary fixation stability. The deformity correction may then be checked using imaging to confirm that the first and second metatarsals are parallel. To secure the bone  400  a fastener, for example, a lag screw, may be inserted into the bone  400 . Alternatively or in addition to the fastener, a bone plate  500 ,  550  may be positioned on and secured to the bone  400 . After the bone is secured any k-wires that remain in the bone  400  may be removed. When necessary, depending on the interphalangeal angle and metatarsophalangeal soft tissue balance, an Akin osteotomy may be performed to complete the correction. Finally, the final toe rotation may be checked and once the desired rotation is achieved the patient may be closed. 
     Referring now to  FIGS.  59 - 106   , another osteotomy system is shown. The devices of the osteotomy system are shown in  FIGS.  59 - 87   . A method of using the devices of the osteotomy system on a patient is shown in  FIGS.  88 - 106   . The osteotomy system may include, for example, an alignment device  600 , a cut guide  700 , a position rotation device  800 , an alignment guide  900 , a plate  1000 , a foot plate k-wire guide  1100 , k-wires or fixation devices, an electric oscillating microsagittal saw or alternative saw  1200 , bone screws  1162 ,  1164 ,  1166 ,  1168 , and a compression fastener  1160 . 
     The alignment device  600  is shown in  FIGS.  59 - 65   . The alignment device  600  may include a base  610 , a shaft  630  coupled to the base  610 , and a handle  640  coupled to the shaft  630 . The base  610  may include a top surface  612  and a bottom surface  614 . The base  610  may also include at least one alignment marking  616 . The at least one alignment marking  616  may be positioned on, for example, the top surface  612  or a side surface of the base  610 . In an embodiment shown in  FIGS.  59 ,  60 ,  63  and  64   , the at least one alignment marking  616  is, for example, two alignment markings  616  positioned on the top surface  612 , an alignment marking  616  positioned on a front side of the base  610 , and an alignment marking  616  positioned on a rear side of the base  610 . The two alignment markings  616  positioned on the top surface  612  may include a first alignment marking  616  positioned at the proximal end and a second alignment marking  616  positioned at the distal end. As best seen in  FIG.  61   , the bottom surface  614  may be, for example, textured or include a plurality of grooves or other surface contours  618 . 
     Further as shown in  FIGS.  59  and  61   , the base  610  may include a plurality of openings  620 ,  622 ,  624 ,  626 ,  628 . The openings  622 ,  624 ,  626 ,  628  may be positioned at a specific rotation angle as they extend through the base  610  from the top surface  612  to the bottom surface  614 . For example, the base  610  may include a zero opening  620  positioned near a center of the base  610 . The zero opening  620  may have, for example, an insertion angle of 0° for inserting a guide wire, k-wire or the like into a patient at a 0° angle. The zero opening  620  may be used for positioning and aligning the alignment device  600 . The base  610  may also include a first angled opening  622  positioned near the shaft  630 . The first angled opening  622  may have, for example, a first rotation angle ranging from 10° to 19° and a guide wire, k-wire or the like may be inserted through the opening  622 . In an embodiment, the first angled opening  622  may be, angled, for example, 7.5° and may have a rotation angle of, for example, 15°. A second angled opening  624  may be positioned between the zero opening  620  and the first angled opening  622 . The second angled opening  624  may have, for example, a second rotation angle ranging from 20° to 29° and a guide wire, k-wire or the like may be inserted through the opening  624 . In an embodiment, the second angled opening  624  may be, angled, for example, 11° and may have a rotation angle of, for example, 22°. A third angled opening  626  may be positioned proximal the zero opening  620 . The third angled opening  626  may have, for example, a third rotation angle ranging from 30° to 39° and a guide wire, k-wire or the like may be inserted through the opening  626 . In an embodiment, the third angled opening  626  may be, angled, for example, 15° and may have a rotation angle of, for example, 30°. The base  610  may also include a fourth angled opening  628  positioned proximal to the third angled opening  626 . The fourth angled opening  628  may have, for example, a fourth rotation angle ranging from 40° to 50° and a guide wire, k-wire or the like may be inserted through the opening  628 . In an embodiment, the fourth angled opening  628  may be, angled, for example, 22.5° and may have a rotation angle of, for example, 45°. As shown in the depicted embodiment of  FIGS.  59 - 61  and  65   , the openings  620 ,  622 ,  624 ,  626  may be positioned linearly along the top surface  612  of the base  610 . The fourth angled opening  628  may be, for example, positioned offset from the openings  620 ,  622 ,  624 ,  626 . The openings  620 ,  622 ,  624 ,  626 ,  628  may be positioned in alternative 2D layouts that ensure that the plantar portion of the osteotomy terminates a certain distance from the joint line, for example, approximately 10 mm. In another embodiment, the first angled opening  622  may be angled, for example, 7.5° for a rotation angle of 15°, the second angled opening  624  may be angled, for example, 12.5° for a rotation angle of 25°, the third angled opening  626  may be angled, for example, 17.5° for a rotation angle of 35°, and the fourth angled opening  628  may be angled, for example, 22.5° for a rotation angle of 45°. 
     With continued reference to  FIGS.  59 - 65   , the shaft  630  includes a first end  632  coupled to the base  610  and a second end  634  coupled to the handle  640 . The shaft  630  may include a first segment  636  near the first end  632  and a second segment  638  near the second end  634 . The first segment  636  may be angled relative to the second segment  638 . The shaft  630  may be positioned offset to one side of the top surface  612 . 
     Referring now to  FIGS.  66 - 71   , the cut guide  700  is shown. The cut guide  700  includes a first or distal end  702  opposite a second or proximal end  704 , a first side  706  opposite a second side portion  708 , and a top surface  710  opposite a bottom surface  712 . The top surface  710  may be, for example, parallel to the bottom surface  712 . The cut guide  700  may also include a curved portion  714  extending from the proximal end  704  to the second side portion  708 . The distal end  702  of the cut guide  700  may include a recessed region  716  extending into the cut guide  700  and forming a leg portion  718 . The leg portion  718  may include a foot portion  720  extending from the first side  706  toward the second side portion  708 . The foot portion  720  may include an opening  722  for receiving a guide wire, k-wire or the like, as described in greater detail below with reference to  FIGS.  92 - 94   . The opening  722  may extend through the cut guide  700  from the top surface  710  to the bottom surface  712 . 
     With continued reference to  FIGS.  66 - 69   , the cut guide  700  may also include a window  724  positioned near the proximal end  704 . The window  724  may extend through the cut guide  700  from a top surface  710  to a bottom surface  712 . The window  724  may be positioned and sized, for example, to provide visualization of the bone. In addition, the cut guide  700  may include at least one cutting slot  726 ,  728  extending between the first side  706  and the second side  708 . The cutting slots  726 ,  728  may also extend through the cut guide  700  from a top surface  710  to a bottom surface  712 . In the embodiment depicted in  FIGS.  66 - 69   , the cut guide  700  may include, for example, two cutting slots  726 ,  728 . The first cutting slot  726  may be positioned, for example, adjacent to the recessed region  716 . The second cutting slot  728  may be, for example, positioned between the first cutting slot  726  and the window  724 . The first and second cutting slots  726 ,  728  may be, for example, positioned parallel to each other. 
     The cut guide  700  may further include a first or zero opening  730  and a plurality of second openings  732  positioned along the curved portion  714  of the cut guide  700 , as shown in  FIGS.  66 - 69   . The cut guide  700  may also include, for example, at least one double opening  734  positioned along the curved portion  714  of the cut guide  700 , as shown in  FIGS.  66 - 69   . Depending on the size of the cut guide  700 , the cut guide  700  may include at least one double opening  734  if the openings  732  of the desired osteotomy cut angles overlap along the curved portion  714  of the cut guide  700 . The openings  730 ,  732 ,  734  may extend through the cut guide  700  from the top surface  710  to the bottom surface  712 . The openings  730 ,  732 ,  734  may be, for example, positioned along the curvature of the curved portion  714 . The openings  730 ,  732  may be sized and shaped or configured to receive a k-wire, guide wire, or the like, described in greater detail below with reference to  FIGS.  92 - 94   . The double opening  734  may be formed by a portion of two openings  732  overlapping. The double opening  734  may be sized and shaped or configured to receive a single k-wire, guide wire, or the like in two different positions within the double opening  734 . Referring now to  FIG.  67   , the first opening  730  may be, for example, a 0° opening and the second openings  732  and double opening  734  may have angles relative to a line connecting the first opening  730  and the distal opening  722 . The angles of the second openings  732  and the double opening  734  range from, for example, approximately 8° to 60°, and more preferably approximately 13° to 55°. In an embodiment, the second openings  732  may include angles of, for example, 13°, 18°, 23°, 28°, 33°, 38°, 42°, 47° and 55° with the 38° and 42° angles forming a double opening  734 . Alternative angles between approximately 13° to 55° are also contemplated. Further, the double opening  734  may include two different angles within the above range of angles. 
     The position rotation device  800  is shown in  FIGS.  72 - 77   . The rotation device includes a base  802  with a top surface  804  opposite a bottom surface  806 , as shown in FIG.  76 . The base  802  also includes a first end  808  opposite a second end  810 . The base  802  may be, for example, curved to form a semi-circle or arc as the base  802  extends from the first end  808  to the second end  810 , as shown in  FIG.  76   . The base  802  may also optionally include a plurality of alignment grooves  812 . The alignment grooves  812  may be inset into a front side of the base  802  and may extend from the top surface  804  through the base  802  to the bottom surface  806 . 
     With continued reference to  FIGS.  72 - 75   , the base  802  further includes a first or zero opening  814  positioned, for example, centered between the first end  808  and the second end  810  of the base  802 . The zero opening  814  may be positioned adjacent to the first end  832  of the shaft  830 . The zero opening  814  may also be positioned, for example, near a back side of the base  802 . The zero opening  814  may have, for example, an insertion angle for a guide wire, k-wire or the like of 0° as the opening  814  extends from the top surface  804  to the bottom surface  806 . The zero opening  814  may be used for positioning and aligning the position rotation device  800  on a patient. The zero opening  814  may be, for example, sized and shaped or configured to receive a guide wire, k-wire or the like, as described in greater detail below with reference to  FIGS.  96  and  97   . 
     As shown in  FIGS.  72 ,  73  and  75   , the base  802  may also include two first angled openings  816 . One first angled opening  816  may be positioned between the zero opening  814  and the first end  808  and be adjacent to the zero opening  814 . The second first angled opening  816  may be positioned between the zero opening  814  and the second end  810  and also be adjacent to the zero opening  814 . The first angled openings  816  may have, for example, first rotation angles relative to the zero opening  814 . The first rotation angles may, for example, range from 10° to 19° and may receive a guide wire, k-wire or the like. 
     The base  802  may further include two second angled openings  818 , as shown in  FIGS.  72 ,  73  and  75   . One second angled opening  818  may be positioned between the zero opening  814  and the first end  808  and the other second angled opening  818  may be positioned between the zero opening  814  and the second end  810 . As shown in the depicted embodiment, the second angled openings  818  may be positioned between the first angled openings  816  and the alignment grooves  812 . The second angled openings  818  may have, for example, second rotation angles relative to the zero opening  814 . The second rotation angles may, for example, range from 20° to 29° and may receive a guide wire, k-wire or the like. 
     In addition, as shown in  FIGS.  72 ,  73  and  75   , the base  802  may include two third angled openings  820 . One third angled opening  820  may be positioned between the zero opening  814  and the first end  808  and the other third angled opening  820  may be positioned between the zero opening  814  and the second end  810 . The third angled openings  820  may have, for example, third rotation angles relative to the zero opening  814 . The third rotation angles may, for example, range from 30° to 39° and may receive a guide wire, k-wire or the like. The third angled openings  820  may be positioned adjacent to the first angled openings  816  and offset from the second angled openings  818 . 
     Further, the base  802  may include two fourth angled openings  822 , as shown in  FIGS.  72 ,  73  and  75   . One fourth angled opening  822  may be positioned between the zero opening  814  and a first end  808  and the other fourth angled opening  822  may be positioned between the zero opening  814  and a second end  810 . The fourth angled openings  822  may have, for example, fourth rotation angles relative to the zero opening  814 . The fourth rotation angles may, for example, range from 40° to 50° and may receive a guide wire, k-wire or the like. The fourth angled openings  822  may be positioned adjacent to the third angled openings  820  and offset from the second angled openings  818 . 
     As shown in  FIGS.  72 ,  73  and  75   , the openings  814 ,  816 ,  818 ,  820 ,  822  may each be, for example, aligned with an alignment groove  812  of the plurality of alignment grooves  812 . The openings  814 ,  816 ,  820 ,  822  may be positioned linearly along the base  802  as it curves from the first end  808  to the second end  810 . It is also contemplated that the openings  814 ,  816 ,  818 ,  820 ,  822  may be positioned, for example, linearly along the base  802  as it curves from the first end  808  to the second end  810 . Alternatively, each of the openings  816 ,  818 ,  820 ,  822  may be, for example, offset from the zero opening  814 . The openings  816 ,  818 ,  820 ,  822  may be positioned, for example, between the zero opening  814  and the alignment grooves  812 . 
     The shaft  830  may include a first end  832  and a second end  834 , as shown in  FIGS.  72 - 77   . The first end  832  may be coupled to the top surface  804  of the base  802  near a center point of the base  802 . The second end  834  may be coupled to a handle  840 . The shaft  830  may include a first segment  836  near the first end  832  and a second segment  838  near the second end  834 . As shown in  FIGS.  74  and  77   , the first segment  836  may be angled relative to the second segment  838 . 
     The alignment guide  900  is shown in  FIGS.  78 - 80   . The alignment guide  900  includes a body or alignment guide  902 , a fixation member  920 , a guide pin protector  930 , a guide wire or pin  940 , and a fastener  1160  (See  FIGS.  105  and  106   ). The body  902  may include an arm  904  with an attachment portion  906  at a first end and an alignment portion  912  at a second end. The arm  904  may be, for example, angled or curved over the alignment portion  912 . The body  902  may also include a through hole  908  in the attachment portion  906  of the body  902 , as seen in  FIG.  80   . Further, the body  902  may include an alignment protrusion  910  extending away from the attachment portion  906 , as shown in  FIGS.  78 - 80   , for engaging an opening  1030  in a bone plate  1000  of  FIGS.  81 - 87   . The alignment protrusion  910  may be used to position the bone plate alignment guide apparatus  900  on the bone plate  1000 . The through hole  908  may be positioned, for example, adjacent to the alignment protrusion  910 , as shown in  FIGS.  78 - 80   . The alignment portion  912  may include, for example, a through hole  914 , as shown in  FIGS.  79 - 80   . The hole  914  may be straight or angled to a desired insertion position relative to the arm  904  of the body  902 . 
     The fixation member  920  may include a knob portion  922  and a shaft portion  924  with an engagement portion  926  for engaging the bone plate  1000  of  FIGS.  81 - 87   . The engagement portion  926  may be, for example, threaded to engage corresponding threads in an opening  1028  in the bone plate  1000 , deformable to be removeably press fit into the opening  1028  in the bone plate  1000 , or similar configurations that achieve a coupling of the guide apparatus  900  to the second alignment guide opening  1028  of the bone plate  1000 . The shaft portion  924  of the fixation member  920  may also include a groove or recessed region  928  positioned adjacent to the engagement portion  926 . 
     The guide pin protector or tissue protector  930 , as shown in  FIGS.  78 - 80   , may include a handle portion  932  at a first end and a shaft  934  extending away from the handle portion  932  to a tip  938  at a second end. The shaft  934  may taper at the second end to form the tip  936 . The guide pin protector  930  may also include a through hole  938  extending from the first end to the second end to enable a guide wire  940  to pass through the tissue protector  930  and into a patient. The guide wire  940  may include a first end  942  and a second end  944 . The first end  942  may be, for example, sharp or pointed for insertion into the patient. 
     The plate or implant  1000  is shown in  FIGS.  81 - 87   . The plate  1000  may include a first end  1002  and a second end  1004  opposite the first end  1002 . The plate  1000  may also include a first portion  1006  extending from the first end  1002  and a second portion  1008  extending from the first portion  1006  to the second end  1004 . The plate  1000  may also include a top surface  1010  opposite a bottom surface  1012 . As shown in  FIGS.  86  and  87   , the top surface  1010  may be, for example, curved as the plate  1000  extends from a first side to a second side, perpendicular to the longitudinal axis of the plate  1000 . In addition, the bottom surface  1012  may be, for example, curved to match the shape or curvature of the bone receiving the plate  1000  as the plate  1000  extends from the first side to the second side, perpendicular to the longitudinal axis of the plate  1000 . 
     With continued reference to  FIGS.  81 - 87   , the first portion  1006  may include at least one opening  1014 ,  1016  for receiving a fastener or bone screw (not shown). The at least one opening  1014 ,  1016  may include, for example, a first opening  1014  positioned near the first end  1002  and a second opening  1016  positioned adjacent to the first opening  1014 . The openings  1014 ,  1016  may include a threaded portion on the interior surface of the openings  1014 ,  1016 . The threaded portion may have, for example, at least one scallop or cutout forming a break in the threads of the threaded portion. The threaded portion and at least one cutout are shaped to lock the fastener or bone screw in the openings  1014 ,  1016 . The at least one opening  1014 ,  1016  may be tapered from the top surface  1010  to the bottom surface  1012  of the plate  1000 . Although only two openings  1014 ,  1016  are shown in the depicted embodiment, it is also contemplated that the first portion  1006  may include, for example, more than two openings  1014 ,  1016  to provide for additional fastening locations to secure the first portion  1006  of the plate  1000  to a patient. The first portion  1006  may also include a first alignment guide opening  1028  for receiving the alignment protrusion  910  of the alignment guide  900 . In addition, the first portion  1006  may include a second alignment guide opening  1030  for receiving the engagement portion  926  of the fixation member  920  to secure the alignment guide  900  to the plate  1000 . 
     With continued reference to  FIGS.  81 - 87   , the second portion  1008  may include a first lobe  1018  extending out from a first side of the plate  1000  and a second lobe  1020  extending out from a second side of the plate  1000 . The second lobe  1020  may extend away from a longitudinal axis of the plate  1000  farther than the first lobe  1018  extends away forming a curved region  1022  between the first and second lobes  1018 ,  1020 . The second portion  1008  may include at least one opening  1024 ,  1026 . For example, a third opening  1024  may be positioned in the first lobe  1018  and a fourth opening  1026  may be positioned in a second lobe  1020 . The openings  1024 ,  1026  may also include a threaded portion on the interior surface of the openings  1024 ,  1026 . The threaded portion may have, for example, at least one scallop or cutout forming a break in the threads of the threaded portion. The threaded portion and at least one cutout are shaped to lock the fastener or bone screw in the openings  1024 ,  1026 . The at least one opening  1024 ,  1026  may be tapered from the top surface  1010  to the bottom surface  1012  of the plate  1000 . Although only two opening s  1024 ,  1026  are shown in the depicted embodiment, it is also contemplated that the second portion  1008  may include, for example, more than two openings  1024 ,  1026  to provide for additional fastening locations to secure the second portion  1008  of the plate  1000  to a patient. 
     Although only one plate  1000  is shown, it is contemplated that the plate  1000  may be available in varying lengths to correspond to the varying angles of the osteotomy and the corresponding vertical inclination angles. As would be understood by one of ordinary skill in the art, as the vertical inclination angle increases the cut will be longer, thus needing a longer plate  1000  for proper placement along the bones. As the size of the plate  1000  increases, the positions of the openings  1014 ,  1016 ,  1024 ,  1026  and alignment openings  1028 ,  1030  may vary to correctly position the alignment device  900  on the plate  1000  and the openings  1014 ,  1016 ,  1024 ,  1026  on the bone portions. Further, the orientation of the alignment opening  1028  to the alignment opening  1030  may change as the length of the plate  1000  and the vertical inclination angle of the osteotomy changes. The change in orientation of the alignment guide openings  1028 ,  1030  provides a more perpendicular screw fixation relative to the osteotomy by changing the alignment guide placement. 
     The foot plate guide  1100  is shown in  FIGS.  88 - 90   . The foot plate guide  1100  may include a foot plate  1102 , a foot plate k-wire guide  1110 , a retainer member  1130  and a guide wire, k-wire or the like  1140 . The foot plate  1102  may also include a plurality of holes  1106  extending through the plate  1102  from a top surface to a bottom surface. The foot plate k-wire guide  1110  may include a first end  1112  opposite a second end  1114  and a first side  1118  opposite a second side  1120 . The foot plate k-wire guide  1110  may also include a center opening  1116  extending between the first and second ends  1112 ,  1114  and the first and second sides  1118 ,  1120 . The foot plate k-wire guide  1110  may also include a plurality of guide wire openings  1122  extending through each of the first side  1118  and second side  1120 . As shown, the plurality of guide wire openings  1122  may be, for example, a plurality of slots  1122  positioned in two columns on each of the first side  1118  and second side  1120 . The plurality of openings  1122  may, for example, range from 1 to 26 openings. The openings  1122  may, for example, correspond to the rotation angle as described in greater detail below with respect to the surgical method. When the foot plate k-wire guide  1110  is attached to the foot plate  1102 , the openings  1122  may be parallel to the foot plate  1102  allowing for k-wires to be inserted or placed parallel to the ground when the foot is pushed up against the foot plate. 
     A surgical method of using the osteotomy system of  FIGS.  59 - 87    is shown in  FIGS.  88 - 106   . The surgical method may be a proximal rotational metatarsal osteotomy performed through a proximal metatarsal oblique plane osteotomy correcting the deformity through rotation. The surgical method may correct a metatarsal internal rotation and the hallux valgus deformity by rotating the metatarsal through an oblique plane with no bone resection. The surgical method may be performed, for example, with no loss of metatarsal length and a broader bone surface contact than with a transverse proximal osteotomy procedure. The surgical method also may allow for correcting a transverse plane deformity by locating the metatarsal parallel to the second metatarsal and correcting an axial plane deformity, i.e. malrotation, to position the bone, for example, first metatarsal, on top of the sesamoids. The surgical method results in a complete transverse and coronal plane deformity correction. 
     The surgical method may include evaluating the severity of the deformity on an anterior-posterior foot x-ray by measuring the intermetatarsal angle. The intermetatarsal angle is obtained by measuring the divergence between the first and second metatarsals. Next, the angle to be corrected is measured to determine the degrees necessary to place the metatarsal head over the sesamoid complex. There may be a limited capacity to evaluate the metatarsal malrotation, due to sesamoid subluxation. In one embodiment, axial sesamoid x-rays can give a rough estimate of first ray malrotation. In another embodiment, a preoperative CT scan may be performed, which could assess metatarsal rotation and sesamoid subluxation. In another embodiment, the metatarsal rotation angle may be assessed by measuring the angle between the floor and hallux with a goniometer. 
     Once the intermetatarsal angle and rotation angle are determined, then the angle of correction or osteotomy cut angle may be determined. In order to avoid having to perform calculations during surgery, the angle of correction or osteotomy cut angle may be determined using Table 5 below. Table 5 includes the most commonly seen values for rotation angle and the most common intermetatarsal angles. In addition, Table 5 includes the osteotomy cut angle selected for each group of rotation angles and intermetatarsal angles. Therefore, it is also contemplated that in alternative embodiments, the osteotomy cut angles listed in Table 5 may be different based on an alternative grouping of the rotation angles and intermetatarsal angles. If there is a remaining interphalangeal deformity then an optional phalangeal osteotomy, for example, an Akin osteotomy, may be performed. 
     
       
         
           
               
               
             
               
                   
                 TABLE 5 
               
             
            
               
                   
                   
               
               
                   
                 Rotation Angle 
               
            
           
           
               
               
               
               
               
            
               
                   
                 10°-19° 
                 20°-29° 
                 30°-39° 
                 40°-50° 
               
               
                   
                   
               
            
           
           
               
               
               
               
               
               
            
               
                 Intermetatarsal Angle 
                  8°-10° 
                 38 
                 28 
                 23 
                 13 
               
               
                   
                 11°-12° 
                 47 
                 33 
                 28 
                 18 
               
               
                   
                 13°-14° 
                 55 
                 38 
                 33 
                 23 
               
               
                   
                 15°-17° 
                 55 
                 42 
                 38 
                 28 
               
               
                   
                 18°-20° 
                 55 
                 47 
                 42 
                 33 
               
               
                   
               
            
           
         
       
     
     Once the correction is determined, a medial approach may be performed. The method may include making an incision, for example, a medial or dorsomedial incision, over the proximal first metatarsal. The method may also optionally include a lateral release for hallux valgus correction to relocate the first metatarsal above the sesamoids. Next, the method may include dissection that is carried down to the base of the first metatarsal. Then, a line or marking  1052  may be etched on the first metatarsal, for example, along the medial midline using a bovie, light skiving with a sagittal saw, electrocautery, or marking pen, as shown in  FIGS.  92 - 101   . 
     Next, the foot plate guide  1100  may be assembled by obtaining a foot plate  1102 , a foot plate k-wire guide  1110 , and a retainer member  1130 . The feet  1124  of the foot plate k-wire guide  1110  may be inserted into the plurality of holes  1106  in the foot plate  1102  from a top surface, as shown in  FIGS.  88 - 90   . The securement openings  1136  of the retainer member  1130  may be aligned with the feet  1124  of the guide  1110  on a bottom surface of the foot plate  1102  and positioned to secure or lock the retainer member  1130  and guide  1110  to the foot plate  1102 , as shown in  FIGS.  89  and  90   . 
     With continued reference to  FIGS.  89  and  90   , the method may further include placing the patient&#39;s foot on the foot plate  1102 . Then, using fluoroscopy the first tarsometatarsal joint may be located and a point, for example, approximately 1-2 cm from the joint may be marked. In an embodiment, where the osteotomy cut angle is less than 47°, the point from the first tarsometatarsal joint may be, for example, approximately 1-1.5 cm from the joint. In another embodiment, where the osteotomy cut angle is greater or equal to 47°, the point from the first tarsometatarsal joint may be, for example, approximately 1.5-2 cm from the joint. Once the point is determined, a k-wire  1140  may be obtained and inserted through the guide  1110  and into the patient&#39;s foot. The k-wire  1140  may be inserted, for example, parallel to the weight-bearing surface, as guided by the foot plate k-wire guide  1110 . In addition, the k-wire  1140  may be inserted, for example, perpendicular to the long axis of the first metatarsal. After the k-wire  1140  is inserted into the first metatarsal, fluoroscopy may be used to confirm the position of the k-wire  1140 . Once the k-wire  1140  is in the desired position, the foot plate k-wire guide  1110  of the coupled foot plate guide  1100  may be slid off the k-wire  1140  and the foot plate guide  1100  may be disassembled after removal from the patient. 
     Referring now to  FIG.  91   , the zero opening  620  of the alignment device  600  may be slid over the k-wire  1140  and the bottom surface  614  of the alignment device  600  positioned on the foot  1050 . Then, the at least one alignment marking  616  may be aligned with a bone marking or laser marking  1052  on the first metatarsal of the foot  1050 . Based on the determined angle of correction, i.e., the rotation angle, a second k-wire or guide wire  1142  may be obtained and inserted into one of the openings  622 ,  624 ,  626 ,  628  that corresponds to the desire rotation angle from Table 5. For example, the second k-wire  1142  may be inserted into the third angled opening  626 , as shown in  FIG.  91   . Next, the first k-wire  1140  may be removed from the patient. 
     As shown in  FIGS.  92  and  93   , the cut guide  700  may be positioned on the foot  1050 . The opening  730 ,  732 ,  734  corresponding to the desired osteotomy cut angle may be slid over the second k-wire  1142 . The side  710 ,  712  corresponding to the operative side of the cut guide  700  may be positioned away from the foot  1050 , as shown in  FIGS.  92  and  93   . The distal end  702  of the cut guide  700  may be aligned on the bone marking  1052 . Then, a third k-wire  1144  may be inserted through the opening  722  in the distal end  702  of the cutting guide  700  to intersect with the bone marking  1052 . 
     Referring now to  FIG.  94   , the saw  1200  may be used to perform the osteotomy. For example, the saw blade  1204  may be inserted through the cutting slot  726 ,  728  in the cut guide  700  to cut the first metatarsal. The cutting slot  726  may be, for example, used when a 55° osteotomy cut angle is calculated or when it is determined that the first k-wire  1140  was placed too close to the joint and the osteotomy cut should be at a more distal location to avoid the first tarsometatarsal joint space. In all other instances, the cutting slot  728  should be used. As shown in  FIG.  94   , the saw blade  1204  may be inserted into the second cutting slot  728  to cut the first metatarsal. After the saw blade  1204  passes through the entire selected cutting slot  726 ,  728 , the cut guide  700  may be removed from the foot  1050 . Then, the saw blade  1204  may be used to complete the osteotomy cut  1054 , as shown in  FIG.  95   . 
     After the osteotomy cut  1054  is complete, the position rotation device  800  may be inserted onto the distal k-wire  1144  in the foot  1050 , as shown in  FIG.  96   . The first or zero opening  814  may be aligned with the distal k-wire  1144  and the position rotation device  800  may be slid onto the k-wire  1144 . The position rotation device  800  may then be aligned onto the first metatarsal. 
     Next, as shown in  FIG.  97   , another k-wire  1146  may be inserted into an opening  816 ,  818 ,  820 ,  822  that corresponds to the rotation angle positioned below the bone marking  1052 . In the depicted embodiment, the k-wire  1146  is inserted into the third angled opening  820  near the first end  808  of the position rotation device  800 . Then, the k-wire  1144  and the position rotation device  800  may be removed from the foot  1050 , as shown in  FIG.  98   . 
     Referring now to  FIGS.  98  and  99   , the k-wire  1146  positioned in the distal portion of the metatarsal may be rotated out of valgus until the distal k-wire  1146  is parallel with the k-wire  1142  positioned in the proximal portion of the metatarsal along the medial aspect of the first metatarsal. The distal k-wire  1146  may be rotated to the identified malrotation angle. The distal k-wire  1146  may be rotated with, for example, a lobster claw clamp (not shown) or pointed reduction forceps (not shown). Once the distal portion of the metatarsal is rotated, as shown in  FIGS.  99  and  100   , the method may include confirming that the medial cortex is flush without any step-off medially and with or without a dorsal step-off. Next, as shown in  FIG.  101   , a k-wire  1148  may be inserted into the foot  1050  across the osteotomy site  1054  from, for example, a dorsal to plantar direction to temporarily fix the osteotomy  1054 . Then, another k-wire  1150  may be inserted from, for example, a plantar to dorsal direction for additional temporary fixation of the osteotomy site  1054 . The method may also include using fluoroscopy to check correction. If the desired correction is achieved, then the k-wires  1142 ,  1146  may be removed. 
     The method may further include fixing the osteotomy site  1054 , as shown in  FIGS.  102 - 106   . For example, obtaining an alignment guide  900  and a plate  1000  and coupling the plate  1000  to the alignment guide  900 . The plate  1000  may be selected based on the osteotomy cut angle. The plate  1000  may be aligned with the alignment guide  900  by positioning the alignment protrusion  910  of the alignment guide  900 , as shown in  FIGS.  78 - 80   , in the second alignment guide opening  1030  in the plate  1000 , as shown in  FIGS.  81  and  84 - 87   . The plate  100  may be coupled to the alignment guide  900  by inserting the engagement portion  926  of the alignment guide  900  into the first alignment guide opening  1028  of the plate  1000 , as discussed in greater detail above, which will not be described again here for brevity sake. Next, the coupled alignment guide  900  and plate  1000  may be placed medially on the first metatarsal, as shown in  FIGS.  102  and  103   . The plate  1000  may be centered along the long axis of the first metatarsal. In addition, the distal openings  1014 ,  1016  and the proximal openings  1024 ,  1026  may be positioned approximately equidistant from the osteotomy site  1054 . Once the plate  1000  is in the desired position, the plate  1000  may be secured to the first metatarsal of the foot  1050  using at least one olive wire or fastener  1152 ,  1154 . Next, the placement of the plate  1000  may be checked using fluoroscopy. 
     After the plate  1000  is temporarily secured to the first metatarsal using the olive wires  1152 ,  1154 , a k-wire  940  may be inserted through the tissue protector  930  of the alignment guide  900  and across the osteotomy site  1054 , as shown in  FIG.  103   . The position and length of the k-wire  940  may then be checked using fluoroscopy. When the k-wire  940  is in the correct position, the alignment guide  900  may be removed from the plate  1000 , as shown in  FIG.  104   . The alignment guide  900  may be removed by, for example, disengaging the engagement portion  926  of the fixation member  920  from the plate  1000  and sliding the tissue protector  930  off the k-wire  940 . Next, a cannulated drill may be inserted over the k-wire  940  to drill an opening (not shown) for inserting a compression screw  1160  across the osteotomy site  1054 . After drilling the opening (not shown), the compression screw  1160  should be selected by, for example, taking measurements for the size and length of the screw  1160  needed. The selected compression screw  1160  may then be inserted across the osteotomy site  1054  and if necessary, countersunk into the metatarsal bone, as shown in  FIG.  105   . The compression screw  1160  may be inserted in a dorsal to plantar direction, as shown, or a plantar to dorsal direction by pushing the k-wire  940  most of the way through the metatarsal bone. Once the compression screw  1160  is secured across the osteotomy site  1054 , the k-wire  940  may be removed from the patient&#39;s foot  1050 , as shown in  FIG.  106   . Then, bone screws  1162 ,  1164 ,  1166 ,  1168  may be inserted through the openings  1014 ,  1016 ,  1024 ,  1026  and into the foot  1050 , as shown in  FIG.  106   . After the screws  1162 ,  1164 ,  1166 ,  1168  are inserted into the foot  1050 , fluoroscopy may be used to confirm the position of the plate  1000  and screws  1162 ,  1164 ,  1166 ,  1168 . 
     When necessary, depending on the interphalangeal angle and metatarsophalangeal soft tissue balance, an Akin osteotomy may be performed to complete the correction. Finally, the final toe rotation may be checked and once the desired rotation is achieved the patient&#39;s incision may be closed. 
     Referring now to  FIGS.  107 - 114   , another cut guide  1300  is shown. The cut guide  1300  includes a first or proximal end  1302  positioned opposite a second or distal end  1304 , a first side  1306  positioned opposite a second side  1308 , and a right side  1310  positioned opposite a left side  1312 . The first side  1306  may be, for example, angled as it extends from the proximal end  1302  to the distal end  1304 . The right side  1310  may be, for example, positioned parallel to the left side  1312 , as shown in  FIG.  112   . The cut guide  1300  may include an extension member  1314  extending away from the cut guide  1300  to the distal end  1304 . The extension member  1314  may include a leg portion  1316  extending from a side of the cut guide  1300  and a foot portion  1318  extending away from the leg portion  1316 . The foot portion  1318  may, for example, have a height that is greater than a height of the leg portion  1316 , as shown in  FIGS.  111 ,  112  and  114   . The right side  1306  may include, for example, a curved portion from the leg portion  1316  to the foot portion  1318  and the left side  1308  may also include, for example, a curved portion from the leg portion  1316  to the foot portion  1318 . The foot portion  1318  may include an opening  1320  extending through the foot portion  1318  from the right side  1310  to the left side  1312 . The opening  1320  may receive a guide wire, k-wire, or the like, to position the cut guide  1300  on a bone. 
     With continued reference to  FIGS.  107 - 114   , the cut guide  1300  may also include at least one cutting slot  1322 ,  1324 ,  1326  extending between the first side  1306  and the second side  1308 . The at least one cutting slot  1322 ,  1324 ,  1326  may extend through the cut guide  1300  from the right side  1310  to the left side  1312 . As shown in  FIGS.  107 - 111  and  113 - 114   , the cut guide  1300  may include, for example, three cutting slots  1322 ,  1324 ,  1326 . The first cutting slot  1322  may be positioned, for example, adjacent to the distal end  1304  of the cutting guide  1300 . The second cutting slot  1324  may be positioned, for example, adjacent to the first cutting slot  1322 . The third cutting slot  1326  may be positioned, for example, toward the proximal end  1302  of the cutting guide  1300  and adjacent to the second cutting slot  1324 . The second cutting slot  1324  may be positioned, for example, between the first cutting slot  1322  and the third cutting slot  1326 . Each of the cutting slots  1322 ,  1324 ,  1326  may be, for example, positioned parallel to each other. 
     The cut guide  1300  may further include a plurality of openings  1328  positioned, for example, along the proximal end  1302  of the cut guide  1300 , as shown in  FIGS.  107 - 111 ,  113 , and  114   . The plurality of openings  1328  may include, for example, overlapping openings  1330 , adjacent openings  1332 , and individual openings  1334 ,  1336 . The overlapping openings  1330  may include, for example, at least two openings that overlap to form a channel of openings. As depicted, the overlapping openings  1330  may include five openings that overlap. The adjacent openings  1332  may include, for example, at least two openings that are positioned directly next to each other and which do not overlap. In the illustrated embodiment, the cut guide  1300  includes the overlapping openings  1330  with five openings positioned proximate to the two adjacent openings  1332 , the opening  1334  is positioned aligned with and spaced apart from the adjacent opening  1332 , and the opening  1336  is positioned aligned with and spaced apart from the opening  1334 . The openings  1330 ,  1332 ,  1334 ,  1336  may be sized and shaped or configured to receive a k-wire, guide wire, or the like, for engaging a bone of a patient. The openings  1330 ,  1332 ,  1334 ,  1336  may extend through the cut guide  1300  from the right side  1310  to the left side  1312 . The openings  1330 ,  1332 ,  1334 ,  1336  may correspond to varying degrees of vertical inclination. In one embodiment, vertical inclination of the openings  1330 ,  1332 ,  1334 ,  1336  may range from, for example, approximately 13° to approximately 55°. In one embodiment, the openings  1330 ,  1332 ,  1334 ,  1336  may have vertical inclinations of, for example, 13°, 18°, 23°, 28°, 33°, 38°, 42°, 47° and 55°. In another embodiment, the openings  1330 ,  1332 ,  1334 ,  1336  may have vertical inclinations of, for example, at least one of 11°, 14°, 16°, 18°, 19°, 21°, 22°, 24°, 25°, 28°, 29°, 31°, 32°, 37°, 38°, 43°, 47°, and 51°. Alternative combinations of angles between approximately 13° to approximately 55° are also contemplated as would be understood by one of ordinary skill in the art. 
     Another position rotation device  1400  is shown in  FIGS.  115 - 123   . The rotation device includes a base  1402  with a top surface  1404  opposite a bottom surface  1406 , as shown in  FIGS.  117 ,  118  and  123   . The base  1402  also includes a first end  1408  opposite a second end  1410 . The base  1402  may be, for example, curved to form a semi-circle or arc as the base  1402  extends from the first end  1408  to the second end  1410 , as shown in  FIGS.  117 ,  118 , and  123   . The base  1402  may also optionally include a center alignment groove  1412 . The alignment groove  1412  may be inset into a front side of the base  1402  and may extend from the top surface  1404  through the base  1402  to the bottom surface  1406 . 
     With continued reference to  FIGS.  115 - 123   , the base  1402  further includes a first or zero opening  1414  positioned, for example, centered between the first end  1408  and the second end  1410  of the base  1402 . The zero opening  1414  may be positioned adjacent to the first end  1432  of the shaft  1430 . The zero opening  1414  may also be positioned, for example, near a back side of the base  1402 . The zero opening  1414  may have, for example, an insertion angle for a guide wire, k-wire or the like of 0° as the opening  1414  extends from the top surface  1404  to the bottom surface  1406 . The zero opening  1414  may be used for positioning and aligning the position rotation device  1400  on a patient. The zero opening  1414  may be, for example, sized and shaped or configured to receive a guide wire, k-wire or the like, for aligning the rotation device  1400  on a patient&#39;s bone. 
     As shown in  FIGS.  115 ,  116 ,  119 ,  120  and  123   , the base  1402  may also include a first set of overlapping openings  1416 . The openings  1416  may be positioned along the front side of the rotation device  1400  between the groove  1412  and the first end  1408 . The base  1402  may also include a second set of overlapping openings  1418 . The openings  1418  may be positioned along the front side of the rotation device  1400  between the groove  1412  and the second end  1410 . The base  1402  may also include a third opening  1420  positioned along the front side of the rotation device  1400  between the first set of openings  1416  and the first end  1408 . The base  1402  may also include a fourth opening  1422  positioned along the front side of the rotation device  1400  between the second set of openings  1418  and the second end  1410 . The openings  1416 ,  1418 ,  1420 ,  1422  may be, for example, angled as they extend from the top surface  1404  to the bottom surface  1406 . The first set of overlapping openings  1416  and the second set of overlapping openings  1418  may each include, for example, three openings. The three overlapping openings  1416 ,  1418  may each have an angle of rotation relative to the zero opening  1414 , for example, the openings  1416 ,  1418  closest to the groove  1412  may have a rotation angle of approximately 10° to 19°. The next openings  1416 ,  1418  may have a rotation angle of, for example, approximately 20° to 29° and the outer most opening  1416 ,  1418  from the groove  1412  may have a rotation angle of, for example, approximately 30° to 39°. Finally, the third and fourth openings  1420 ,  1422  may have rotation angles relative to the zero opening  1414  of, for example, approximately 40° to 50°. In one embodiment, the rotation angles may be, for example, 15°, 25°, 35°, and 45°. In yet another embodiment, the rotation angles may be, for example, 15°, 22°, 30°, and 45°. The openings  1414 ,  1416 ,  1420 ,  1422  may be positioned linearly along the base  1402  as it curves from the first end  1408  to the second end  1410  and offset from the zero opening  1414 . Alternatively, each of the openings  1416 ,  1418 ,  1420 ,  1422  may be, for example, offset from each other and the zero opening  1414 . 
     With continued reference to  FIGS.  115 - 123   , the shaft  1430  may include a first end  1432  and a second end  1434 . The first end  1432  may be coupled to the top surface  1404  of the base  1402  near a center point of the base  1402 . The second end  1434  may be coupled to a handle  1440 . The shaft  1430  may include a first segment  1436  near the first end  1432  and a second segment  1438  near the second end  1434 . As shown in  FIGS.  121  and  122   , the first segment  1436  may be angled relative to the second segment  1438 . 
     Referring now to  FIG.  124   , a system  1500  is shown. The system  1500  may include at least one of an alignment device  100 ,  150 ,  600 , an alignment guide  900 , a plate  500 ,  550 ,  1000 , a cut guide  200 ,  700 ,  1300 , and a position rotation device  300 ,  350 ,  800 ,  1400 . As depicted, in one embodiment the system includes, for example, an alignment device  600 , an alignment guide  900 , a plate  1000 , a cut guide  1300 , and a position rotation device  1400 . The system may include any combination of the alignment devices  100 ,  150 ,  600 , alignment guides  900 , plates  500 ,  550 ,  1000 , cut guides  200 ,  700 ,  1300 , and a position rotation devices  300 ,  350 ,  800 ,  1400  as would be understood by one of ordinary skill in the art. 
     As may be recognized by those of ordinary skill in the art based on the teachings herein, numerous changes and modifications may be made to the above-described and other embodiments of the present disclosure without departing from the scope of the disclosure. The alignment devices, cut guides, position rotation devices, plates, and other components of the devices, implants, and/or systems as disclosed in the specification, including the accompanying abstract and drawings, may be replaced by alternative component(s) or feature(s), such as those disclosed in another embodiment, which serve the same, equivalent or similar purpose as known by those skilled in the art to achieve the same, equivalent or similar results by such alternative component(s) or feature(s) to provide a similar function for the intended purpose. In addition, the devices, implants and systems may include more or fewer components or features than the embodiments as described and illustrated herein. For example, the components and features of the alignment devices of  FIGS.  1 - 9   ,  FIGS.  10 - 16   , and  FIGS.  59 - 65    may all be used interchangeably and in alternative combinations as would be modified or altered by one of skill in the art. Also, the components and features of the cut guides of  FIGS.  17 - 22   ,  FIGS.  66 - 71   , and  FIGS.  107 - 114    may all be used interchangeably and in alternative combinations as would be modified or altered by one of skill in the art. In addition, the components and features of the position rotation devices of  FIGS.  23 - 28   ,  FIGS.  29 - 34   ,  FIGS.  72 - 77   , and  FIGS.  115 - 123    may all be used interchangeably and in alternative combinations as would be modified or altered by one of skill in the art. The components and features of the plates of  FIGS.  35 - 41   ,  FIGS.  42 - 48   , and  FIGS.  81 - 87    may all be used interchangeably and in alternative combinations as would be modified or altered by one of skill in the art. Further, the components and features of the systems disclosed herein and including any combination of the alignment devices of  FIGS.  1 - 9   ,  FIGS.  10 - 16   , and  FIGS.  59 - 65   , the cut guides of  FIGS.  17 - 22   ,  FIGS.  66 - 71   , and  FIGS.  107 - 114   , the position rotation devices of  FIGS.  23 - 28   ,  FIGS.  29 - 34   ,  FIGS.  72 - 77   , and  FIGS.  115 - 123   , the plates of  FIGS.  35 - 41   ,  FIGS.  42 - 48   , and  FIGS.  81 - 87   , and the alignment guide of  FIGS.  78 - 80    may all be used interchangeably and in alternative combinations as would be modified or altered by one of skill in the art. Accordingly, this detailed description of the currently-preferred embodiments is to be taken in an illustrative, as opposed to limiting of the disclosure. 
     The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprise” (and any form of comprise, such as “comprises” and “comprising”), “have” (and any form of have, such as “has”, and “having”), “include” (and any form of include, such as “includes” and “including”), and “contain” (and any form of contain, such as “contains” and “containing”) are open-ended linking verbs. As a result, a method or device that “comprises,” “has,” “includes,” or “contains” one or more steps or elements possesses those one or more steps or elements, but is not limited to possessing only those one or more steps or elements. Likewise, a step of a method or an element of a device that “comprises,” “has,” “includes,” or “contains” one or more features possesses those one or more features, but is not limited to possessing only those one or more features. Furthermore, a device or structure that is configured in a certain way is configured in at least that way, but may also be configured in ways that are not listed. 
     The invention has been described with reference to the preferred embodiments. It will be understood that the architectural and operational embodiments described herein are exemplary of a plurality of possible arrangements to provide the same general features, characteristics, and general system operation. Modifications and alterations will occur to others upon a reading and understanding of the preceding detailed description. It is intended that the invention be construed as including all such modifications and alterations.