Abstract:
Bone fixation systems include various combinations of stabilizing members, dynamic elements, fasteners, and locking mechanisms. Bone plates receive dynamic bone staples and bone screws. Other dynamic elements include elbow pegs, straight pegs, and wire pegs.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    The present application claims the benefit of: 
         [0002]    U.S. Provisional Application Ser. No. 62/192,059, Attorney&#39;s Docket No. CES-2 PROV, entitled BONE PLATES WITH DYNAMIC ELEMENTS, which was filed on Jul. 13, 2015. 
         [0003]    The present application is also a continuation-in-part of: 
         [0004]    International Patent Application Serial No. PCT/US2014/070495, Attorney&#39;s Docket No. CES-117249-2 PCT, entitled POLYAXIAL LOCKING HOLE, which was filed on Dec. 16, 2014. 
         [0005]    International Patent Application Serial No. PCT/US2014/070495 claims the benefit of: 
         [0006]    U.S. Provisional Patent Application Ser. No. 61/919,069, Attorney&#39;s Docket No. CES-117249-2 PROV, entitled POLYAXIAL LOCKING HOLE, which was filed on Dec. 20, 2013. 
         [0007]    The present application is also a continuation-in-part of: 
         [0008]    International Patent Application Serial No. PCT/US2015/039551, Attorney&#39;s Docket No. CES-117249-3 PCT, entitled BONE IMPLANT AND MEANS OF INSERTION, which was filed on Jul. 8, 2015. 
         [0009]    International Patent Application Serial No. PCT/US2015/039551 claims the benefit of: 
         [0010]    U.S. Provisional Patent Application Ser. No. 62/022,811, Attorney&#39;s Docket No. CES-117249-3 PROV, entitled BONE IMPLANT AND MEANS OF INSERTION, which was filed on Jul. 10, 2014. 
         [0011]    The present application is also a continuation-in-part of: 
         [0012]    International Patent Application Serial No. PCT/US2015/039556, Attorney&#39;s Docket No. CES-117249-5 PCT, entitled BONE IMPLANT WITH ANTI-ROTATION, which was filed on Jul. 8, 2015. 
         [0013]    International Patent Application Serial No. PCT/US2015/039556 claims the benefit of: 
         [0014]    U.S. Provisional Patent Application Ser. No. 62/022,811, Attorney&#39;s Docket No. CES-117249-3 PROV, entitled BONE IMPLANT AND MEANS OF INSERTION, which was filed on Jul. 10, 2014; and 
         [0015]    U.S. Provisional Patent Application Ser. No. 62/036,240, Attorney&#39;s Docket No. CES-117249-5 PROV, entitled BONE IMPLANT WITH ANTI-ROTATION, which was filed on Aug. 12, 2014. 
         [0016]    The foregoing are incorporated by reference as though set forth herein in their entirety. 
     
    
     TECHNICAL FIELD 
       [0017]    The present disclosure relates to plates having dynamic elements, otherwise known as elastic elements. Plates with dynamic elements may be used to stabilize and apply continuous load to hard tissues such as bone, or to soft tissues such as cartilage or ligaments. The present disclosure relates to plates with dynamic elements that provide continuous load across a joint, a resection, an osteotomy, a fracture, a tear, a laceration, or some other discontinuity between hard or soft tissue portions. The continuous load may be compressive or tensile. The present disclosure is made in the context of bone plates for use in the foot, having various dynamic elements including staples, elbow pegs or L-pegs, and straight pegs. However, the principles disclosed herein are applicable in locations throughout the body. 
       BACKGROUND 
       [0018]    There are many circumstances in which bones, bone fragments, or other tissue portions must be fused together, united, or otherwise permanently joined. Some examples include arthrodesis, corrective osteotomy, fracture, tear, or laceration. Bones, bone fragments, or other tissue portions heal better when they are stabilized with some mechanical load or stress across the discontinuity, for example when the bones, bone fragments, or other tissue portions are compressed together or distracted apart. This disclosure describes solutions to the problem of stabilizing bones, bone fragments, or other tissue portions while applying a therapeutic level of continuous mechanical load or stress across the discontinuity. 
       SUMMARY 
       [0019]    The various systems and methods of the present technology have been developed in response to the present state of the art, and in particular, in response to the problems and needs in the art that have not yet been fully solved by currently available fixation systems. The systems and methods of the present technology may provide a means for dynamic loading while providing an overall stable construct. 
         [0020]    To achieve the foregoing, and in accordance with the technology as embodied and broadly described herein, plate members provide stabilization and/or deformity correction in conjunction with dynamic elements that provide continuous dynamic load between tissue portions. The plate members may or may not be used with the dynamic elements. The dynamic elements may be separate parts that may be attached to the plate members, or they may be integrally formed with the plate members. The plate members and the dynamic elements may be made from the same materials or from different materials. The dynamic elements may be made from any elastic material, preferably a highly elastic metal, preferably a superelastic metal, preferably nitinol. 
         [0021]    These and other features and advantages of the present technology will become more fully apparent from the following description and appended claims, or may be learned by the practice of the technology as set forth hereinafter. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0022]    Exemplary embodiments of the technology will become more fully apparent from the following description and appended claims, taken in conjunction with the accompanying drawings. Understanding that these drawings depict only exemplary embodiments and are, therefore, not to be considered limiting of the scope of the technology, the exemplary embodiments will be described with additional specificity and detail through use of the accompanying drawings in which: 
           [0023]      FIG. 1A  is an oblique view of an assembly with a bone plate, a staple, and screws;  FIG. 1B  is another oblique view of the assembly of  FIG. 1A  from a different direction;  FIG. 1C  is a side view of the assembly of  FIG. 1A ;  FIG. 1D  is a longitudinal cross-section of the assembly of  FIG. 1A  along a mid-sagittal plane of the bone plate;  FIG. 1E  is an exploded oblique view of the assembly of  FIG. 1A ; and  FIG. 1F  is another exploded oblique view of the assembly of  FIG. 1A  from a different direction. 
           [0024]      FIG. 2  is an oblique view of an assembly with the bone plate of  FIG. 1A  and screws. 
           [0025]      FIG. 3A  is an oblique view of an assembly with a bone plate, a staple, and a set screw;  FIG. 3B  is another oblique view of the assembly of  FIG. 3A  from a different direction;  FIG. 3C  is a side view of the assembly of  FIG. 3A ;  FIG. 3D  is a longitudinal cross-section of the assembly of  FIG. 3A  along a mid-sagittal plane of the bone plate;  FIG. 3E  is an exploded oblique view of the assembly of  FIG. 3A ; and  FIG. 3F  is another exploded oblique view of the assembly of  FIG. 3A  from a different direction. 
           [0026]      FIG. 4A  is an oblique view of an assembly with a bone plate and a staple;  FIG. 4B  is another oblique view of the assembly of  FIG. 4A  from a different direction;  FIG. 4C  is an exploded oblique view of the assembly of  FIG. 4A ;  FIG. 4D  is another exploded oblique view of the assembly of  FIG. 4A  from a different direction;  FIG. 4E  is yet another oblique view of the assembly of  FIG. 4A , showing a tab in a closed configuration;  FIG. 4F  is a side view of the assembly of  FIG. 4E ; and  FIG. 4G  is a longitudinal cross-section of the assembly of  FIG. 4E  along a mid-sagittal plane of the bone plate. 
           [0027]      FIG. 5A  is an oblique view of an assembly with a bone plate and a staple insert molded within the bone plate;  FIG. 5B  is another oblique view of the assembly of  FIG. 5A  from a different direction;  FIG. 5C  is a side view of the assembly of  FIG. 5A ;  FIG. 5D  is a longitudinal cross-section of the assembly of  FIG. 5A  along a mid-sagittal plane of the bone plate;  FIG. 5E  is an exploded oblique view of the assembly of  FIG. 5A ; and  FIG. 5F  is another exploded oblique view of the assembly of  FIG. 5A  from a different direction. 
           [0028]      FIG. 6A  is an oblique view of an assembly with a bone plate, elbow pegs, and screws;  FIG. 6B  is another oblique view of the assembly of  FIG. 6A  from a different direction;  FIG. 6C  is a side view of the assembly of  FIG. 6A ;  FIG. 6D  is a longitudinal cross-section of the assembly of  FIG. 6A  along a mid-sagittal plane of the bone plate;  FIG. 6E  is an exploded oblique view of the assembly of  FIG. 6A ; and  FIG. 6F  is another exploded oblique view of the assembly of  FIG. 6A  from a different direction. 
           [0029]      FIG. 7A  is an oblique view of an assembly with a bone plate, elbow pegs, and set screws;  FIG. 7B  is another oblique view of the assembly of  FIG. 7A  from a different direction;  FIG. 7C  is a side view of the assembly of  FIG. 7A ;  FIG. 7D  is a longitudinal cross-section of the assembly of  FIG. 7A  along a mid-sagittal plane of the bone plate, showing one of the elbow pegs in an insertion configuration and another one of the elbow pegs in a final configuration;  FIG. 7E  is an exploded oblique view of the assembly of  FIG. 7A ; and  FIG. 7F  is another exploded oblique view of the assembly of  FIG. 7A  from a different direction. 
           [0030]      FIG. 8A  is an oblique view of an assembly with a bone plate, straight pegs, and set screws;  FIG. 8B  is another oblique view of the assembly of  FIG. 8A  from a different direction;  FIG. 8C  is a side view of the assembly of  FIG. 8A ;  FIG. 8D  is a longitudinal cross-section of a portion of the assembly of  FIG. 8A  along a mid-sagittal plane of the bone plate, showing one of the straight pegs in an insertion configuration;  FIG. 8E  is a longitudinal cross-section of a portion of the assembly of  FIG. 8A  along a mid-sagittal plane of the bone plate, showing another one of the straight pegs in a final configuration;  FIG. 8F  is an exploded oblique view of the assembly of  FIG. 8A ; and  FIG. 8G  is another exploded oblique view of the assembly of  FIG. 8A  from a different direction. 
           [0031]      FIG. 9A  is a lateral oblique view of the bones of a human right foot; and  FIG. 9B  is a medial view of the bones of a human right foot. 
           [0032]      FIG. 10  is an oblique view of a kit of bone plates. 
           [0033]      FIG. 11  is another oblique view of the bone plate of  FIG. 1A . 
           [0034]      FIG. 12A  is an oblique view of the screws of  FIG. 1A ; and  FIG. 12B  is a side view of the screws of  FIG. 1A . 
           [0035]      FIG. 13A  is an oblique cross-section detail view of the non-locking screw of  FIG. 1A  in a hole of the bone plate of  FIG. 1A ; and  FIG. 13B  is an oblique cross-section detail view of the locking screw of  FIG. 1A  in a hole of the bone plate of  FIG. 1A . 
           [0036]      FIG. 14  is an oblique view of a kit of surgical instruments. 
           [0037]      FIG. 15  is an oblique view of a sizing template of the kit of  FIG. 14 . 
           [0038]      FIG. 16A  is an oblique detail view of a plate of  FIG. 10  with two benders of the kit of  FIG. 14 ; and  FIG. 16B  is an oblique detail view of the plate and a bender of  FIG. 16A . 
           [0039]      FIG. 17A  is an oblique detail view of the plate and benders of  FIG. 16A ;  FIG. 17B  is an oblique detail view of the plate and bender of  FIG. 16B , with an additional bender; and  FIG. 17C  is an oblique detail view of the plate and benders of  FIG. 17B . 
           [0040]      FIG. 18  is a medial oblique view of some of the bones of a human left foot, a bone plate, and a threaded drill guide of the kit of  FIG. 14  which doubles as a plate inserter tool.  FIG. 18  shows the step of inserting the bone plate. 
           [0041]      FIG. 19A  is a detail view of a portion of the threaded drill guide of  FIG. 18 ; and  FIG. 19B  is a medial oblique view of some of the bones of a human left foot, the bone plate of  FIG. 18 , two threaded drill guides of  FIG. 18 , and an olive wire of the kit of  FIG. 14 .  FIG. 19B  shows the step of drilling for a locking screw. 
           [0042]      FIG. 20A  is an oblique view of a non-locking polyaxial drill guide of the kit of  FIG. 14  and a threaded plate bender of the kit of  FIG. 14  which doubles as a handle for the non-locking polyaxial drill guide; and  FIG. 20B  is a medial oblique view of some of the bones of a human left foot, the bone plate and threaded drill guide of  FIG. 18 , and the non-locking polyaxial drill guide with threaded plate bender of  FIG. 20A .  FIG. 20B  shows the step of drilling for a non-locking screw. 
           [0043]      FIG. 21  is a medial oblique view of some of the bones of a human left foot, the bone plate and threaded drill guide of  FIG. 18 , the screw of  FIG. 1A , and a screw driver of the kit of  FIG. 14 .  FIG. 21  shows the step of driving a locking screw. 
           [0044]      FIG. 22A  is a medial oblique view of some of the bones of a human left foot, the bone plate of  FIG. 18 , the screws of  FIG. 1A , and a staple drill guide of the kit of  FIG. 14 ;  FIG. 22B  is a medial oblique view of some of the bones of a human left foot, the bone plate of  FIG. 18 , the screws of  FIG. 1A , and a staple inserter of the kit of  FIG. 14 ; and  FIG. 22C  is a medial oblique view of some of the bones of a human left foot, the bone plate of  FIG. 18 , the screws of  FIG. 1A , and a staple. 
           [0045]      FIG. 23  is a medial oblique view of some of the bones of a human left foot, the bone plate of  FIG. 18 , the screws of  FIG. 1A , and a staple. 
           [0046]      FIG. 24A  is an oblique view of an assembly with a bone plate and straight threaded pegs;  FIG. 24B  is another oblique view of the assembly of  FIG. 24A  from a different direction;  FIG. 24C  is a side view of the assembly of  FIG. 24A ;  FIG. 24D  is a longitudinal cross-section of a portion of the assembly of  FIG. 24A  along a mid-sagittal plane of the bone plate;  FIG. 24E  is an oblique view of a portion of a straight peg inserter instrument;  FIG. 24F  is an oblique view of the assembly of  FIG. 24A  with the inserter instrument of  FIG. 24E , with one straight peg partially inserted;  FIG. 24G  is another oblique view of the assembly of  FIG. 24A  with the inserter instrument of  FIG. 24E , with both straight pegs fully inserted;  FIG. 24H  is a cross sectional view of a portion of the components of  FIG. 24G ;  FIG. 24I  is an exploded oblique view of the assembly of  FIG. 24A ; and  FIG. 24J  is another exploded oblique view of the assembly of  FIG. 24A  from a different direction. 
           [0047]      FIG. 25A  is an oblique view of an assembly with a bone plate, wire pegs, and set screws;  FIG. 25B  is another oblique view of the assembly of  FIG. 25A  from a different direction;  FIG. 25C  is a side view of the assembly of  FIG. 25A ;  FIG. 25D  is a longitudinal cross-section of a portion of the assembly of  FIG. 25A  along a mid-sagittal plane of the bone plate;  FIG. 25E  is an oblique view of the wire peg of  FIG. 25A  in a free state;  FIG. 25F  is a cross sectional view of a portion of the assembly of  FIG. 25A , with a wire peg in a free state;  FIG. 25G  is an exploded oblique view of the assembly of  FIG. 25A ; and  FIG. 25H  is another exploded oblique view of the assembly of  FIG. 25A  from a different direction. 
           [0048]      FIG. 26A  is an oblique view of an assembly with a bone plate, wire pegs, and set screws;  FIG. 26B  is another oblique view of the assembly of  FIG. 26A  from a different direction;  FIG. 26C  is a side view of the assembly of  FIG. 26A ;  FIG. 26D  is a longitudinal cross-section of a portion of the assembly of  FIG. 26A  along a mid-sagittal plane of the bone plate;  FIG. 26E  is an oblique view of the wire peg of  FIG. 26A  in a free state;  FIG. 26F  is a cross sectional view of a portion of the assembly of  FIG. 26A , with a wire peg in a free state;  FIG. 26G  is an exploded oblique view of the assembly of  FIG. 26A ; and  FIG. 26H  is another exploded oblique view of the assembly of  FIG. 26A  from a different direction. 
           [0049]      FIG. 27A  is an oblique view of a wire peg in a free state; and  FIG. 27B  is a side view of the wire peg of  FIG. 27A . 
           [0050]      FIG. 28A  is an oblique view of an assembly with a bone plate, staples, and screws;  FIG. 28B  is another oblique view of the assembly of  FIG. 28A  from a different direction;  FIG. 28C  is a side view of the assembly of  FIG. 28A ;  FIG. 28D  is a longitudinal cross-section of the assembly of  FIG. 28A  along a mid-sagittal plane of the bone plate;  FIG. 28E  is an exploded oblique view of the assembly of  FIG. 28A ; and  FIG. 28F  is another exploded oblique view of the assembly of  FIG. 28A  from a different direction. 
       
    
    
     DETAILED DESCRIPTION 
       [0051]    Exemplary embodiments of the technology will be best understood by reference to the drawings, wherein like parts are designated by like numerals throughout. It will be readily understood that the components of the technology, as generally described and illustrated in the figures herein, could be arranged and designed in a wide variety of different configurations. Thus, the following more detailed description of the embodiments of the apparatus, system, and method is not intended to limit the scope of the invention, as claimed, but is merely representative of exemplary embodiments of the technology. 
         [0052]    The phrases “connected to,” “coupled to” and “in communication with” refer to any form of interaction between two or more entities, including mechanical, electrical, magnetic, electromagnetic, fluid, and thermal interaction. Two components may be functionally coupled to each other even though they are not in direct contact with each other. The term “abutting” refers to items that are in direct physical contact with each other, although the items may not necessarily be attached together. The phrase “fluid communication” refers to two features that are connected such that a fluid within one feature is able to pass into the other feature. 
         [0053]    The word “exemplary” is used herein to mean “serving as an example, instance, or illustration.” Any embodiment described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other embodiments. While the various aspects of the embodiments are presented in drawings, the drawings are not necessarily drawn to scale unless specifically indicated. 
         [0054]    Standard medical planes of reference and descriptive terminology are employed in this specification. A sagittal plane divides a body into right and left portions. A mid-sagittal plane divides the body into bilaterally symmetric right and left halves. A coronal plane divides a body into anterior and posterior portions. A transverse plane divides a body into superior and inferior portions. Anterior means toward the front of the body. Posterior means toward the back of the body. Superior means toward the head. Inferior means toward the feet. Medial means toward the midline of the body. Lateral means away from the midline of the body. Axial means toward a central axis of the body. Abaxial means away from a central axis of the body. Ipsilateral means on the same side of the body. Contralateral means on the opposite side of the body. These descriptive terms may be applied to an animate or inanimate body. 
         [0055]    In this specification, an elastically deformed state is defined as deformation equivalent to strain values above 0.2%, for example strain values between 0.2% and 6%. An elastically deformed state is distinct from the small magnitude of deformation and strain tolerated by most materials under load. 
         [0056]    In this specification, a static material, or a static design, or a static component, is defined as a material, design, or component that tolerates deformation equivalent to no more than 0.2% strain before experiencing permanent plastic deformation, bending, cracking, breaking, or other failure mode. 
         [0057]    Referring to  FIGS. 1A-1F , an assembly  100  may include a stabilizing member, a dynamic element, and one or more fasteners. In assembly  100 , the stabilizing member may be a bone plate  102 , the dynamic element may be a staple  104 , and the fasteners may be screws. Assembly  100  is illustrated with locking screws  106  on the left and non-locking screws  108  on the right. 
         [0058]    The bone plate  102  has an obverse side  112  and a reverse side  114 . When the bone plate  102  is implanted, the obverse side  112  faces away from the bone portions and the reverse side  114  faces toward the bone portions. The bone plate  102  includes several holes  116  which extend through the obverse and reverse sides  112 ,  114 . Six holes  116  are illustrated, although any number of holes may be present. Each hole  116  includes an internally threaded portion  118  and a non-threaded portion  120  so that each hole  116  accepts either the locking screw  106  or the non-locking screw  108 . See  FIGS. 13A and 13B . The internally threaded portion  118  engages external threads  119  on the head  107  of the locking screw  106 . The internally threaded portion  118  may be adjacent to the reverse side  114 . The non-threaded portion  120  engages the head  109  of the non-locking screw  108 . The non-threaded portion  120  may be adjacent to the obverse side  112 . The non-threaded portion  120  may be concave and/or elongated. An optional groove  122  in the obverse side  112  extends between two of the holes  116 . Each of these two holes  116  is also elongated toward the other hole  116 , leaving a web  124  extending between the two holes  116 . The web  124  may be adjacent to the reverse side  114 . The web  124  separates the two holes  116 , and may be present even if the holes  116  are not elongated towards each other. The optional groove  122  if present, the two elongated holes  116 , and the web  124  are referred to collectively as a receiver  126 , and the involved holes  116  are referred to as receiver holes  128 . A receiver  126  may be included between any two holes through a bone plate. Multiple receivers  126  may be included on a single bone plate. For example, referring to  FIGS. 1A and 1E , the bone plate  102  may be modified to include a second receiver between the left two holes  116  and/or a third receiver between the right two holes  116 . Two receivers  126  may share a common receiver hole  128 . The bone plate  102  may be much more stiff than the dynamic element, which in this example is the staple  104 . The bone plate  102  may be rigid, or static as defined above. Alternatively, the bone plate  102  may be malleable or elastic. The bone plate  102  may include rigid and malleable regions. The illustrated bone plate  102  may be 2 mm thick in the vicinity of the receiver  126  and 1.5 mm thick in the vicinity of the leftmost two holes  116  and the rightmost two holes  116 . The bone plate  102  may accommodate a staple  104  that is 18 mm×14 mm. The bone plate  102  is also illustrated in  FIG. 11 . 
         [0059]    Referring to  FIG. 10 , several different bone plate shapes may be provided in a kit or a set.  FIG. 10  shows, from left to right, a left double Y plate  102 , a left Y plate, a right Y plate  902 , a straight 4-hole plate, and a straight 5-hole plate. A kit or set may also include a left metatarsophalangeal plate with 10 degree varus and zero degree dorsiflexion (not shown), and a right metatarsophalangeal plate with 10 degree varus and zero degree dorsiflexion (not shown). 
         [0060]    The staple  104  is described in at least one of the patent applications identified in paragraphs [0001]-[0015] of this application. The staple  104  may be the implant  200  of  FIGS. 11 and 12 , implant  300  of  FIGS. 15A-16B , implant  600  of  FIGS. 21 and 22 , implant  800  of  FIGS. 23A-24 , or implant  2200  of  FIGS. 78 and 79  of International Patent Application Serial No. PCT/US2015/039551; or implant  100  of  FIGS. 1-3 , staple  300  of  FIGS. 4 and 5 , staple  400  of  FIG. 7 , staple  480  of  FIG. 8 , or implant  2100  of  FIGS. 10A and 10B  of International Patent Application Serial No. PCT/US2015/039556. 
         [0061]    The staple  104  includes a body  140  or bridge, a first leg  142 , and a second leg  144 . The bridge extends between a first end  146  and a second end  148 . The first leg  142  is coupled to the first end  146  and terminates in a first free end  143 . The second leg  144  extends from the second end  148  and terminates in a second free end  145 . 
         [0062]    The staple  104  has an insertion state, or elastically deformed state, which is its shape under the influence of an external force, for example, an external force applied by a staple inserter tool. A first distance separates the free ends  143 ,  145  in the elastically deformed state. The staple  104  also has a free state, or relaxed state, which is its shape when no external forces are acting upon the staple, other than gravity. A second distance separates the free ends  143 ,  145  in the relaxed state. The second distance is different from the first distance. In the example shown, the legs  142 ,  144  of the staple  104  are parallel to one another in the elastically deformed state. However, the legs  142 ,  144  may converge or diverge in the elastically deformed state. In the example shown, the legs  142 ,  144  of the staple converge at their free ends, or tips, in the relaxed state, so that the second distance is less than the first distance. However, the legs  142 ,  144  may diverge at their free ends, or the legs  142 ,  144  may be parallel in the relaxed state. The staple  104  assumes the elastically deformed state under the influence of an external force. The staple  104  may resume the free state as soon as the external force is removed. If the legs  142 ,  144  of the staple  104  are engaged in bone holes, then the staple may only be able to partially relax toward the free state due to the resistance of the bone. In this situation, the staple  104  may be in a loaded state in between the elastically deformed state and the relaxed state. The loaded state of the staple is shown in  FIGS. 1A-1F . The staple  104  is preferably made of a superelastic alloy such as nitinol, although other materials are also suitable. In this example, the staple  104  is not locked to the bone plate  102 , although in subsequent examples the staple is locked to the bone plate. In this example, the body  140  of the staple  104  rests within the groove  122  of the receiver  126  against the web  124 , and the staple legs  142 ,  144  extend through the receiver holes  128  and protrude from the reverse side  114  of the bone plate  102 . The web  124  prevents the body  140  from passing through the reverse side  114  of the bone plate  102 . The receiver  126  holds the staple  104  in a predetermined orientation and relative position with respect to the bone plate  102 . The receiver  126  is one example of a group of features that function together to hold a staple a in a predetermined orientation and relative position with respect to a bone plate. Different features, or groups of features, may provide the same function. For example, the groove  122  may be lacking so that the body  140  of the staple  104  rests atop the obverse side  112  of the bone plate  102 , or the web  124  may be replaced by ledges or other supports to serve as a stop or a docking point to prevent the body  140  from passing through the reverse side  114 . Furthermore, the web  124  may be replaced by one or more stop feature(s) or docking feature(s) on the staple  104  instead of on the bone plate  102 . 
         [0063]    The locking screw  106  locks securely to any hole  116  in the bone plate  102 . The locking screw  106  may include an externally threaded head  107  which locks to the hole  116  in the bone plate  102  when threaded tightly into the internally threaded portion  118  of the hole  116 . The locking screw  106  may be the design disclosed in at least one of the patent applications identified in paragraphs [0001]-[0015] of this application. The locking screw  106  may be the bone fixation device  390  of  FIG. 11 , bone fixation device  500  of  FIGS. 24-26 , bone fixation device  600  of  FIGS. 27-30  of International Patent Application Serial No. PCT/US2014/070495. The locking screw may have a 3.0 mm diameter and lengths from 8 mm to 30 mm in 2 mm increments. The locking screw  106  is also illustrated in  FIG. 12 . 
         [0064]    The non-locking screw  108  does not lock to the holes  116  in the bone plate  102 . Instead, it remains free to rotate and translate within the confines of the screw hole  116  after implantation. The non-locking screw  108  may be polyaxially positionable relative to the screw hole  116 . The non-locking screw  108  may include a head  109  with an exterior surface that forms a ball-and-socket joint with the non-threaded portion  120  of the hole  116 . The exterior surface may be convex, spherical, or conical. The non-locking screw  108  may have a 3.5 mm diameter and lengths from 8 mm to 30 mm in 2 mm increments. The non-locking screw  108  is also illustrated in  FIG. 12 . 
         [0065]    Referring to  FIG. 13 , the screws  106  and  108  are interchangeable in the screw holes  116  of the bone plate  102 . 
         [0066]    Referring to  FIG. 2 , an assembly  200  may include a stabilizing member and one or more fasteners. In assembly  200 , the stabilizing member may be the bone plate  102  and the fasteners may include one or more of the screws  106  and/or  108 . This example includes a locking screw  106  in one of the receiver holes, showing that the screws  106  or  108  can be used interchangeably in the receiver holes  128  as well as the other holes  116  of the bone plate  102 . 
         [0067]    Referring to  FIGS. 3A-3F , an assembly  300  may include a stabilizing member, a dynamic element, and one or more fasteners. In assembly  300 , the stabilizing member may be a bone plate  302 , the dynamic element may be the staple  104 , and the fasteners may include a set screw  310  and one or more of the screws  106  and/or  108 , although the screws  106  and  108  are omitted from the illustration for clarity. 
         [0068]    The bone plate  302  has an obverse side  312  and a reverse side  314 . The bone plate  302  includes several holes  316 , each of which may include an internally threaded portion  318  and a non-threaded portion  320 , the same as hole  116 . The internally threaded portion  318  may be adjacent to the reverse side  314  and the non-threaded portion  320  may be adjacent to the obverse side  312 . An optional groove  322  in the obverse side  312  extends between two of the holes  316 . Each of these two holes  316  is also elongated toward the other hole  316 , leaving a web  324  extending between the two holes  316 . The web  324  may be adjacent to the reverse side  314 . The web  324  separates the two holes  316 , and may be present even if the holes  316  are not elongated towards each other. The web  324  prevents the body  140  from passing through the reverse side  314 . The optional groove  322  if present, the two elongated holes  316 , and the web  324  are referred to collectively as a receiver  326 , and the involved holes  316  are referred to as receiver holes  328 . The bone plate  302  includes an internally threaded socket  338  which receives the set screw  310  in threaded engagement. The set screw  310  locks the staple  104  to the bone plate  302 , and may be referred to as a locking mechanism. 
         [0069]    Referring to  FIGS. 4A-4G , an assembly  400  may include a stabilizing member, a dynamic element, and one or more fasteners. In assembly  400 , the stabilizing member may be a bone plate  402 , the dynamic element may be the staple  104 , and the fasteners may include one or more of the screws  106  and/or  108 , although the screws  106  and  108  are omitted from the illustration for clarity. 
         [0070]    The bone plate  402  has an obverse side  412  and a reverse side  414 . The bone plate  402  includes several holes  416 , each of which may include an internally threaded portion  418  and a non-threaded portion  420 , the same as hole  116 . The internally threaded portion  418  may be adjacent to the reverse side  414  and the non-threaded portion  420  may be adjacent to the obverse side  412 . An optional groove  422  in the obverse side  412  extends between two of the holes  416 . Each of these two holes  416  is also elongated toward the other hole  416 , leaving a web  424  extending between the two holes  416 . The web  424  may be adjacent to the reverse side  414 . The web  424  separates the two holes  416 , and may be present even if the holes  416  are not elongated towards each other. The web  424  prevents the body  140  from passing through the reverse side  414 . The optional groove  422  if present, the two elongated holes  416 , and the web  424  are referred to collectively as a receiver  426 , and the involved holes  416  are referred to as receiver holes  428 . The bone plate  402  includes a ductile tab  430  that extends from the obverse side  412  beside the receiver  426 . There may be more than one tab  430 . The tab  430  couples the staple  104  to the bone plate  402 . The tab  430  may therefore be considered one of the fasteners, and may be referred to as a locking mechanism. The tab  430  is illustrated in an open state in  FIGS. 4A-4D , and in a closed state in  FIGS. 4E-4G . In the open state, the staple  104  may be inserted into the receiver  426 . In the closed state, the tab  430  prevents the staple  104  from being removed from the receiver. The tab  430  may be bent over the staple  104  in the closed state. The tab  430  may experience plastic deformation, also known as permanent deformation, so that the tab  430  remains bent over the staple  104  unless bent back towards the open state. The tab  430  may be closed intraoperatively, or the assembly  400  may be provided coupled together with the tab  430  closed as shown in  FIGS. 4E-4G . 
         [0071]    Other means for locking the staple  104  to a bone plate are contemplated, such as a snap fit between the staple  104  and the bone plate (not shown). 
         [0072]    Referring to  FIGS. 5A-5F , an assembly  500  may include a stabilizing member, a dynamic element, and one or more fasteners. In assembly  500 , the stabilizing member may be a bone plate  502 , the dynamic element may be the staple  104 , and the fasteners may be one or more of the screws  106  and/or  108 , although the screws  106  and  108  are omitted from the illustration for clarity. 
         [0073]    The bone plate  502  has an obverse side  512  and a reverse side  514 . The bone plate  502  includes several holes  516 , each of which may include an internally threaded portion  518  and a non-threaded portion  520 , the same as hole  116 . The internally threaded portion  518  may be adjacent to the reverse side  514  and the non-threaded portion  520  may be adjacent to the obverse side  512 . Two of the holes  516  are elongated toward each other, leaving a web  524  extending between the two holes  516 . The two elongated holes  516  in this example lack the internally threaded portion  518 . The web  524  may be adjacent to the reverse side  514 . The web  524  separates the two holes  516 , and may be present even if the holes  516  are not elongated towards each other. The web  524  prevents the body  140  from passing through the reverse side  514 . The two elongated holes  516  and web  524  are referred to collectively as a receiver  526 , and the involved holes  516  are referred to as receiver holes  528 . In this example, the bone plate  502  is formed around the staple  104  at least partially so that the staple  104  is inseparable from the bone plate  502  in normal use. The web  524  encircles a middle portion of the body  140  of the staple  104 , leaving lateral portions of the staple body  140  and the staple legs  142 ,  144  free to flex between the relaxed state and the elastically deformed state. Alternately, the staple  104  may be partially or fully encapsulated in an elastically deformable material that bends with the staple as the staple moves between the relaxed state and the elastically deformed state. The bone plate  502  may be made of polyetheretherketone (PEEK) which is overmolded around the staple  104 . The staple  104  may be insert molded into the bone plate  502 . The bone plate  502  and staple  104  may be integrally formed of a single material, preferably a highly elastic material such as nitinol. The staple included in assembly  500  may be a modified version of staple  104 . The modifications may facilitate manufacturing the bone plate  502  and the staple as a unit. 
         [0074]    Referring to  FIGS. 6A-6F , an assembly  600  may include a stabilizing member, a dynamic element, and one or more fasteners. In assembly  600 , the stabilizing member may be a bone plate  602 , the dynamic element may be an elbow peg  604  also known as an L-peg, and the fasteners may be one or more of the screws  106  and/or  108 . 
         [0075]    The bone plate  602  has an obverse side  612  and a reverse side  614 . The bone plate  602  includes several holes  616 . The holes  616  may lack an internally threaded portion like hole  116 . A groove  622  in the obverse side  612  extends between two of the holes  616  and within the holes, forming a shelf  623  within each hole  616 . The shelf  623  may be adjacent to the reverse side  614 . Each of these two holes  616  is also elongated toward the other hole  616 , leaving a web  624  extending between the two holes  616 . The web  624  may be adjacent to the reverse side  614 . The web  624  separates the two holes  616 , and may be present even if the holes  616  are not elongated towards each other. The groove  622 , two elongated holes  616 , and web  624  are referred to collectively as a receiver  626 , and the holes  616  are referred to as receiver holes  628 , since these features receive the elbow pegs  604 . 
         [0076]    Two elbow pegs  604  are shown facing each other in the assembly  600 . In this example, the elbow pegs  604  take the place of the previous dynamic element, the staple  104 . Each elbow peg  604  includes a head  632  and a bone-contacting leg  634 , which terminates in a free end  635 . The head  632  may be shaped like a ring, as illustrated, or it may be any shape, such as rectangular, square, oval, polygonal, etc. The head  632  may be perpendicular, or nearly perpendicular, to the leg  634 . For example, the head  632  and the leg  634  may form an angle of 90 degrees±10 degrees, 90 degrees±15 degrees, or 90 degrees±20 degrees. Alternatively, the head  632  may form an acute angle or an obtuse angle with the leg  634 . Each elbow peg  604  may be independently inserted into a bone hole and secured to the bone plate  602 . The elbow peg  604  may be secured to the bone plate  602  by a bone screw, such as screw  106  or  108 , through an aperture  636  through the head  632 . The shelf  623  prevents the head  632  from passing through the reverse side  614  of the bone plate  602 . The elbow peg  604  may develop some spring force as the bone screw is fully seated, as explained more fully below with regard to assembly  700 . The spring force may be linear or nonlinear. The elbow peg  604  may exert force due to simple leverage without substantive spring force. 
         [0077]    While two elbow pegs  604  are shown, a single elbow peg  604  may be used opposite a locking screw  106 . This arrangement is not shown. In this case, the bone plate  602  would have an internally threaded hole  616  at one end (like hole  116  of bone plate  102 ) and at the other end, a receiver hole  628 . The assembly would include a locking screw  106  in the internally threaded hole  616  and an elbow peg  604  plus a screw in the receiver hole  628 . 
         [0078]    In a further modification of assembly  600 , a screw  108  and an elbow peg  604  may be used together with no other apparatus. In this case, the screw  108  and the leg  634  of the elbow peg  604  may lie on opposite sides of the discontinuity between tissue portions. A screw  106  may also be used in this fashion, in which case the aperture  636  through the head  632  of the elbow peg  604  preferably includes an internally threaded portion to engage the external threads  119  on the head  107  of the screw  106 . 
         [0079]    Referring to  FIGS. 7A-7F , an assembly  700  may include a stabilizing member, a dynamic element, and one or more fasteners. In assembly  700 , the stabilizing member may be a bone plate  702 , the dynamic element may be an elbow peg  704  also known as an L-peg, and the fasteners may be one or more of the set screws  310 . 
         [0080]    The bone plate  702  has an obverse side  712  and a reverse side  714 . The bone plate  702  includes several holes  716 , each of which may include an internally threaded portion  718 . The internally threaded portion  718  may be adjacent to the obverse side  712 . Each hole  716  may include an interior shelf  723 . The shelf  723  may be adjacent to the reverse side  714 . Two of the holes  716  are elongated toward each other, leaving a web  724  extending between the two holes  716 . The web  724  may be adjacent to the reverse side  714 . The web  724  separates the two holes  716 , and may be present even if the holes  716  are not elongated towards each other. The two elongated holes  716  and web  724  are referred to collectively as a receiver  726 , and the involved holes  716  are referred to as receiver holes  728 , since these features receive the elbow pegs  704 . 
         [0081]    Two elbow pegs  704  are shown facing each other in the assembly  700 . In this example, the elbow pegs  704  take the place of the previous dynamic element, the staple  104 . Each elbow peg  704  includes a head  732  and a bone-contacting leg  734 , which terminates in a free end  735 . The head  732  may be rounded, as illustrated, or it may be any shape. The head  732  may be perpendicular, or nearly perpendicular, to the leg  734 . For example, the head  732  and the leg  734  may form an angle of 90 degrees±10 degrees, 90 degrees±15 degrees, or 90 degrees±20 degrees. Alternatively, the head  732  may form an acute angle or an obtuse angle with the leg  734 . Each elbow peg  704  may be independently inserted into a bone hole and secured to the bone plate  702 . The elbow peg  704  may be secured to the bone plate  702  by the set screw  310  against the head  734 . The shelf  723  prevents the head  732  from passing through the reverse side  714  of the bone plate  702 . The elbow peg  704  may develop some spring force as the set screw  310  is fully seated.  FIG. 7D  shows a free state elbow peg  704  in the left hole. The head  732  and the leg  734  form an obtuse angle in the free state. A compressed elbow peg  704  is shown in the right hole. As a result of driving the set screw  310  tightly against the head  732 , the elbow peg  704  is elastically bent to a 90 degree state, which is an elastically deformed state. The leg  734  exerts a force against the bone, acting toward the left-hand elbow peg  704 . The force may be linear or nonlinear. A similar principle may apply to the elbow pegs  604  described for assembly  600 . The elbow peg  704  may exert force due to simple leverage without substantive spring force. 
         [0082]    While two elbow pegs  704  are shown, a single elbow peg  704  may be used opposite a locking screw  106 . This arrangement is not shown. In this case, the bone plate would have an internally threaded hole  716  at one end (like hole  116  of bone plate  102 ) and at the other end, a receiver hole  728 . The assembly would include a locking screw  106  in the internally threaded hole  716  and an elbow peg  704  plus a set screw  310  in the receiver hole  728 . 
         [0083]    Referring to  FIGS. 8A-8G , an assembly  800  may include a stabilizing member, a dynamic element, and one or more fasteners. In assembly  800 , the stabilizing member may be a bone plate  802 , the dynamic element may be a straight peg  804 , and the fasteners may be one or more of the set screws  310 . 
         [0084]    The bone plate  802  has an obverse side  812  and a reverse side  814 . The bone plate  802  includes several holes  816 , each of which may include an internally threaded portion  818 . The internally threaded portion  818  may be adjacent to the obverse side  812 . Each hole  816  may include an interior shelf  823 . The shelf  823  may be adjacent to the reverse side  814 . A web  824  extends between two of the holes  816 . The web  824  may be adjacent to the reverse side  814 . The web  824  separates the two holes  816 , and may be present even if the holes  816  are elongated towards each other. The two holes  816  are referred to as receiver holes  828 , since these features receive the straight pegs  804 . 
         [0085]    Two straight pegs  804  are shown facing each other in the assembly  800 . In this example, the straight pegs  804  take the place of the previous dynamic elements, the staple  104  or the elbow pegs  604 ,  704 . Each straight peg  804  includes a head  832  and a bone-contacting leg  834 , which terminates in a free end  835 . The head  832  may be rounded, as illustrated, or it may be any shape. The head  832  may include a mark  837 , such as an arrowhead pointing toward the free end  835  of the leg  834  ( FIG. 8F ). The head  832  may form an obtuse angle, a right angle, or an acute angle with the leg  834  ( FIG. 8E ). Each straight peg  804  may be independently inserted into a bone hole and secured to the bone plate  802 . The straight peg  804  may be secured to the bone plate  802  by the set screw  310  against the head  832 . The shelf  823  prevents the head  832  from passing through the reverse side  814  of the bone plate  802 . The straight peg  804  is free to rotate about its head  832  within the receiver hole  828 , at least until secured by the set screw  310 . Alternatively, the straight peg  804  may be rotationally constrained relative to the receiver hole  828  to a set of discrete rotational positions. The head  832  and/or the leg  834  of the straight peg  804  may be non-circular, and may engage a complementary non-circular portion of the receiver hole  828 . A similar arrangement is illustrated in  FIGS. 25A-H . Whether the straight pegs  804  are free to rotate or constrained to discrete rotational positions, the assembly  800  can deliver dynamic load in multiple directions relative to the bone plate  802  and/or other straight pegs  804 . The mark  837  (arrowhead) may assist in orienting each leg  834  in the desired direction.  FIGS. 8D and 8E  illustrate that the straight peg  804  may develop spring force as the set screw  310  is fully seated, according to the same principles described for assembly  700  above. However, in  FIG. 8E , the straight peg  804  is illustrated in its free state, having rotated counterclockwise due to the action of the set screw  310 . If the leg  834  were constrained to the position shown in  FIG. 8D , perpendicular to the bone plate  802 , then the straight peg  804  would develop spring force as the set screw  310  is tightened. 
         [0086]    While two straight pegs  804  are shown, a single straight peg  804  may be used opposite a locking screw  106 . This arrangement is not shown. In this case, the bone plate would have an internally threaded hole  816  at one end (like hole  116  of bone plate  102 ) and at the other end, a receiver hole  828 . The assembly would include a locking screw  106  in the internally threaded hole  816  and a straight peg  804  plus a set screw  310  in the receiver hole  828 . 
         [0087]    Referring to  FIGS. 24A-24J , an assembly  1000  may include a stabilizing member and a dynamic element. In assembly  1000 , the stabilizing member may be the bone plate  602  and the dynamic element may be a straight peg  1004 . 
         [0088]    Two straight pegs  1004  are shown facing each other in the assembly  1000 . In this example, the straight pegs  1004  take the place of the previous dynamic elements, the staple  104  or the elbow pegs  604 ,  704  or the straight peg  804 . Each straight peg  1004  includes a rounded head  1032  and a bone-contacting leg  1034 , which terminates in a free end  1035 . The head  1032  may form an obtuse angle, a right angle, or an acute angle with the leg  1034  ( FIG. 24D ). The head  1032  may include a mark pointing toward the free end  1035  of the leg  1034 , similar to mark  837  of straight peg  804 . The leg  1034  may include external threads as shown, or the leg  1034  may be smooth. Each straight peg  1004  may be independently inserted into a bone hole and secured to the bone plate  602 . The straight peg  1004  may be secured to the bone plate  602  by threading the leg  1034  into bone, or with a set screw  310  as explained previously. The shelf  623  prevents the head  1032  from passing through the reverse side  614  of the bone plate  602 . The straight peg  1004  may develop spring force, according to similar principles to those described above.  FIG. 24E  illustrates an inserter tool  1040  for temporarily straightening the angle between the head  1032  and the leg  1034 , and for threading the leg  1034  into a bone hole. The inserter tool  1040  includes a torque drive feature  1042  (a hex) with a distal shaft  1044  that extends within a cannulation  1033  in the straight peg  1004 . 
         [0089]    While two straight pegs  1004  are shown, a single straight peg  1004  may be used opposite a locking screw  106 . This arrangement is not shown. In this case, the bone plate  602  would have an internally threaded hole  616  at one end (like hole  116  of bone plate  102 ) and at the other end, a receiver hole  628 . The assembly would include a locking screw  106  in the internally threaded hole  616  and a straight peg  1004  in the receiver hole  628 . 
         [0090]    Referring to  FIGS. 25A-25H , an assembly  1100  may include a stabilizing member, a dynamic element, and one or more fasteners. In assembly  1100 , the stabilizing member may be a bone plate  1102 , the dynamic element may be a wire peg  1104 , and the fastener may include a set screw  310 . 
         [0091]    The bone plate  1102  has an obverse side  1112  and a reverse side  1114 . The bone plate  1102  includes several holes  1116 , each of which may include an internally threaded portion  1118 . The internally threaded portion  1118  may be adjacent to the obverse side  1112 . Each hole  1116  may include an interior shelf  1123 . The shelf  1123  may be adjacent to the reverse side  1114 . A web  1124  extends between two of the holes  1116 . The web  1124  may be adjacent to the reverse side  1114 . The web  1124  separates the two holes  1116 , and may be present even if the holes  1116  are elongated towards each other. The two holes  1116  are referred to as receiver holes  1128 , since these features receive the wire pegs  1104 . Each receiver hole  1128  includes a noncircular through hole  1129 . The illustrated holes  1129  are rectangular, and may be square. 
         [0092]    Two wire pegs  1104  are shown facing each other in the assembly  1100 . In this example, the wire pegs  1104  take the place of the previous dynamic elements, the staple  114 , the elbow pegs  604 ,  704 , the straight pegs  804 ,  1004 . Each wire peg  1104  is formed from a sharply bent, or folded, piece of wire having a rectangular cross section. Each wire peg  1104  includes a head  1132  and a bone-contacting leg  1134 , which terminates in a free end  1135  where the wire is sharply bent or folded. The head  1132  in this example is formed by outwardly bent ends, or terminal portions, of the wire. The head  1132  may form an obtuse angle, a right angle, or an acute angle with the leg  1134 . In  FIG. 25E-F , the outwardly bent wire ends of the head  1132  form right angles with the leg  1134  when the wire peg  1104  is in the free state. The outwardly bent wire ends of the head  1132  are uneven when the wire peg  1104  is in the free state. Each wire peg  1104  may be independently inserted into a bone hole and secured to the bone plate  1102 . The wire peg  1104  may be secured to the bone plate  1102  with a set screw  310 . The shelf  1123  prevents the head  1132  from passing through the reverse side  1114  of the bone plate  1102 . The wire peg  1104  may develop spring force and may bow sideways as the set screw  310  is tightened, due to the uneven height of the outwardly bent wire ends of the head  1132 . The stressed or bowed state of the wire peg  1104  is illustrated in  FIGS. 25A-25D, 25G, and 25H . 
         [0093]    While two wire pegs  1104  are shown, a single wire peg  1104  may be used opposite a locking screw  116 . This arrangement is not shown. In this case, the bone plate would have an internally threaded hole  1116  at one end (like hole  116  of bone plate  102 ) and at the other end, a receiver hole  1128 . The assembly would include a locking screw  116  in the internally threaded hole  1116  and a wire peg  1104  with a set screw  310  in the receiver hole  1128 . 
         [0094]    Referring to  FIGS. 26A-26H , an assembly  1200  may include a stabilizing member, a dynamic element, and one or more fasteners. In assembly  1200 , the stabilizing member may be a bone plate  1202 , the dynamic element may be a wire peg  1204 , and the fastener may include a set screw  310 . 
         [0095]    The bone plate  1202  has an obverse side  1212  and a reverse side  1214 . The bone plate  1202  includes several holes  1216 , each of which may include an internally threaded portion  1218 . The internally threaded portion  1218  may be adjacent to the obverse side  1212 . Each hole  1216  may include an interior shelf  1223 . The shelf  1223  may be adjacent to the reverse side  1214 . The shelf  1223  may include a medial alcove  1221 . A web  1224  extends between two of the holes  1216 . The web  1224  may be adjacent to the reverse side  1214 . The web  1224  separates the two holes  1216 , and may be present even if the holes  1216  are elongated towards each other. The two involved holes  1216  are referred to as receiver holes  1228 , since these features receive the wire pegs  1204 . Each receiver hole  1228  includes a noncircular through hole  1229 . The illustrated holes  1229  are elongated, and may be oval, round, or another shape such as rectangular or square. 
         [0096]    Two wire pegs  1204  are shown facing each other in the assembly  1200 . In this example, the wire pegs  1204  take the place of the previous dynamic elements, the staple  104 , the elbow pegs  604 ,  704 , the straight pegs  804 ,  1004 , or the wire peg  1104 . Each wire peg  1204  is formed from a sharply bent, or folded, piece of wire having a round cross section. Each wire peg  1204  includes a head  1232  and a bone-contacting leg  1234 , which terminates in a free end  1235  where the wire is sharply bent or folded. The head  1232  in this example is formed by outwardly bent ends, or terminal portions, of the wire. The head  1232  may form an obtuse angle, a right angle, or an acute angle with the leg  1234 . In  FIG. 26E-F , the outwardly bent wire ends of the head  1232  form right angles with the leg  1234  when the wire peg is in the free state. The outwardly bent wire ends of the head  1232  are uneven when the wire peg is in the free state. Each wire peg  1204  may be independently inserted into a bone hole and secured to the bone plate  1202 . The wire peg  1204  may be secured to the bone plate  1202  with a set screw  310 . The wire peg  1204  may develop spring force and may bow sideways as the set screw is tightened, due to the uneven height of the outwardly bent wire ends of the head  1232 . The stressed or bowed state of the wire peg  1204  is illustrated in  FIGS. 26A-26D, 26G, and 26H . 
         [0097]    While two wire pegs  1204  are shown, a single wire peg  1204  may be used opposite a locking screw  126 . This arrangement is not shown. In this case, the bone plate would have an internally threaded hole  1216  at one end (like hole  116  of bone plate  102 ) and at the other end, a receiver hole  1228 . The assembly would include a locking screw  126  in the internally threaded hole  1216  and a wire peg  1204  with a set screw  310  in the receiver hole  1228 . 
         [0098]    Referring to  FIGS. 27A and 27B , an alternative wire peg  1302  is formed from a sharply bent, or folded, piece of wire having a round cross section. Each wire peg  1304  includes a head  1332  and a bone-contacting leg  1334 , which terminates in a free end  1335  where the wire is sharply bent or folded. The head  1332  in this example is formed by an outwardly bent end, or terminal portion, of the wire and a straight end of the wire. The head  1332  may form an obtuse angle, a right angle, or an acute angle with the leg  1334 . In  FIG. 26E-F , the outwardly bent wire end of the head  1332  forms a right angle with the leg  1334  when the wire peg is in the free state. The outwardly bent wire end of the head  1332  is uneven with the straight end of the head  1332  when the wire peg is in the free state. This wire peg  1302  may be used interchangeably with the wire pegs  1102  and  1202 . 
         [0099]    Referring to  FIGS. 28A-28F , an assembly  1400  may include a stabilizing member, a dynamic element, and one or more fasteners. In assembly  1400 , the stabilizing member may be a bone plate  1402 , the dynamic element may be a staple  1404 , and the fasteners may be screws. Assembly  1400  is illustrated with locking screws  1406  on the left and non-locking screws  1408  on the right. 
         [0100]    The bone plate  1402  has an obverse side  1412  and a reverse side  1414 . The bone plate  1402  includes several holes  1416  which extend through the obverse and reverse sides  1412 ,  1414 . Sixteen holes  1416  are illustrated, although any number of holes may be present. Each hole  1416  includes an internally threaded portion  1418  and a non-threaded portion  1420  so that each hole  1416  accepts either the locking screw  1406  or the non-locking screw  1408 . The internally threaded portion  1418  engages external threads  1419  on the head  1407  of the locking screw  1406 . The internally threaded portion  1418  may be adjacent to the reverse side  1414 . The non-threaded portion  1420  engages the head  1409  of the non-locking screw  1408 . The non-threaded portion  1420  may be adjacent to the obverse side  1412 . The non-threaded portion  1420  may be concave and/or elongated. An optional groove  1422  in the obverse side  1412  extends along a line of six holes  1416  that extend along the midline of the plate  1402 . Each of these six holes  1416  is also elongated, leaving webs  1424  extending between the second and third holes  1416  and the fourth and fifth holes  1416 . No webs are shown between the first and second holes  1416 , the third and fourth holes  1416 , or the fifth and sixth holes  1416 , although these webs may be present. The webs  1424  may be adjacent to the reverse side  1414 . The webs  1424  separate the second and third holes  1416  and the fourth and fifth holes  1416 , respectively, and may be present even if the holes  14416  are not elongated. The first and second holes  1416  are referred to collectively as a receiver  1426 , and the involved holes  1416  are referred to as receiver holes  1428 . A second receiver  1426  includes the third and fourth holes  1416 , and a third receiver  1426  includes the fifth and sixth holes  1416 . 
         [0101]    The staple  1404  is described in at least one of the patent applications identified in paragraphs [0001]-[0015] of this application. The staple  1404  may be the implant  200  of  FIGS. 11 and 12 , implant  300  of  FIGS. 15A-16B , implant  600  of  FIGS. 21 and 22 , implant  800  of  FIGS. 23A-24 , or implant  2200  of  FIGS. 78 and 79  of International Patent Application Serial No. PCT/US2015/039551; or implant  100  of  FIGS. 1-3 , staple  300  of  FIGS. 4 and 5 , staple  400  of  FIG. 7 , staple  480  of  FIG. 8 , or implant  2100  of  FIGS. 10A and 10B  of International Patent Application Serial No. PCT/US2015/039556. The illustrated staple  1404  is the implant  2200  of  FIGS. 78 and 79  of International Patent Application Serial No. PCT/US2015/039551. 
         [0102]    The staple  1404  includes a body  1440  or bridge, a first leg  1442 , and a second leg  1444 . The bridge extends between a first end  1446  and a second end  1448 . The first leg  1442  is coupled to the first end  1446  and terminates in a first free end  1443 . The second leg  1444  extends from the second end  1448  and terminates in a second free end  1445 . A first projection  1450  extends from the first end  1446  and a second projection  1452  extends from the second end  1448 . 
         [0103]    The staple  1404  has an insertion state, or elastically deformed state, which is its shape under the influence of an external force, for example, an external force applied by a staple inserter tool. A first distance separates the free ends  1443 ,  1445  in the elastically deformed state. The staple  1404  also has a free state, or relaxed state, which is its shape when no external forces are acting upon the staple, other than gravity. A second distance separates the free ends  1443 ,  1445  in the relaxed state. The second distance is different from the first distance. In the example shown, the legs  1442 ,  1444  of the staple  1404  are parallel to one another in the elastically deformed state. However, the legs  1442 ,  1444  may converge or diverge in the elastically deformed state. In the example shown, the legs  1442 ,  1444  of the staple converge at their free ends  1443 ,  1445 , or tips, in the relaxed state, so that the second distance is less than the first distance. However, the legs  1442 ,  1444  may diverge at their free ends  1443 ,  1445 , or the legs  1442 ,  1444  may be parallel in the relaxed state. The staple  1404  assumes the elastically deformed state under the influence of an external force. The staple  1404  may resume the free state as soon as the external force is removed. If the legs  1442 ,  1444  of the staple  1404  are engaged in bone holes, then the staple may only be able to partially relax toward the free state due to the resistance of the bone. In this situation, the staple  1404  may be in a loaded state in between the elastically deformed state and the relaxed state. In this example, the staple  1404  is not locked to the bone plate  1402 , although in other examples the staple is locked to the bone plate. In this example, the body  1440  of the staple  1404  rests within the receiver  1426 , and the staple legs  1442 ,  1444  extend through the receiver holes  1428  and protrude from the reverse side  1414  of the bone plate  1402 . The receiver  1426  holds the staple  1404  in a predetermined orientation and relative position with respect to the bone plate  1402 . The receiver  1426  is one example of a group of features that function together to hold a staple a in a predetermined orientation and relative position with respect to a bone plate. Different features, or groups of features, may provide the same function. For example, the body  1440  of the staple  1404  may rest atop the obverse side  1412  of the bone plate  1402 , or on a web, or the web  1424  may be replaced by ledges or other supports to serve as a stop or a docking point to prevent the body  1440  from passing through the reverse side  1414 . Furthermore, the web  1424  may be replaced by one or more stop feature(s) or docking feature(s) on the staple  1404  instead of on the bone plate  1402 . For example, the projections  1450 ,  1452  may serve as stop features or docking features. 
         [0104]    The locking screw  1406  locks securely to any hole  1416  in the bone plate  1402 . The locking screw  1406  may include an externally threaded head  1407  which locks to the hole  1416  in the bone plate  1402  when threaded tightly into the internally threaded portion  1418  of the hole  1416 . The locking screw  1406  may be the design disclosed in at least one of the patent applications identified in paragraphs [0001]-[0015] of this application. The locking screw  1406  may be the bone fixation device  390  of  FIG. 11 , bone fixation device  500  of  FIGS. 24-26 , bone fixation device  600  of  FIGS. 27-30  of International Patent Application Serial No. PCT/US2014/070495. 
         [0105]    The non-locking screw  1408  does not lock to the holes  1416  in the bone plate  1402 . Instead, it remains free to rotate and translate within the confines of the screw hole  1416  after implantation. The non-locking screw  1408  may be polyaxially positionable relative to the screw hole  1416 . The non-locking screw  1408  may include a head  1409  with an exterior surface that forms a ball-and-socket joint with the non-threaded portion  1420  of the hole  1416 . The exterior surface may be convex, spherical, or conical. 
         [0106]    The screws  1406  and  1408  are interchangeable in the screw holes  1416  of the bone plate  1402 . 
         [0107]    Referring to  FIGS. 9A and 9B , a normal human foot  10  includes twenty-six bones, including a talus  12 , a calcaneus  14 , a navicular  16 , a medial cuneiform  18 , an intermediate cuneiform  20 , a lateral cuneiform  22 , a cuboid  24 , a first metatarsal  26 , a second metatarsal  28 , a third metatarsal  30 , a fourth metatarsal  32 , a fifth metatarsal  34 , a first proximal phalanx  36 , a second proximal phalanx  38 , a third proximal phalanx  40 , a fourth proximal phalanx  42 , a fifth proximal phalanx  44 , a first middle phalanx  46 , a second middle phalanx  48 , a third middle phalanx  50 , a fourth middle phalanx  52 , a first distal phalanx  54 , a second distal phalanx  56 , a third distal phalanx  58 , a fourth distal phalanx  60 , and a fifth distal phalanx  62 . 
         [0108]    Referring to  FIG. 14 , several different surgical instruments may be provided in a kit or a set. From top to bottom, left to right,  FIG. 14  illustrates a plate template, a threaded drill guide/depth gage, a polyaxial drill guide/depth gage, a bender/handle, a staple drill guide, an olive wire, drills (such as 2.0 mm and 2.5 mm diameters), and a self-retaining screwdriver (not shown) and a screwdriver handle, such as an AO quick connect handle (not shown). 
         [0109]    Referring to  FIG. 15 , a plate sizing template may include several individual templates for different plate shapes, each of which may be removed from, or “punched out” of, or torn away from the sizing template. The template may be provided sterile. Templating may be a step in a method for using the disclosed apparatus. 
         [0110]    Referring to  FIGS. 16A, 16B, and 17A-17C , a plate bender may include a threaded end and a forked end opposite the threaded end. The threaded end threads into the plate holes, as shown in  FIGS. 17B and 17C . The forked end receives the plate, as shown in  FIGS. 16A and 17A . The plate bender may also be used as a handle for the non-locking polyaxial drill guide ( FIG. 20 ). Multiple plate benders may be provided in a kit or set of instruments. The plate bender(s) may be provided sterile. Plate bending or plate contouring may be a step in a method for using the disclosed apparatus. Plates may be bent in-situ or on a back table in an operating room. 
         [0111]    Referring to  FIG. 18 , a threaded drill guide may lock into a threaded hole in a bone plate, for example bone plate  902 , to accurately guide a drill to make a hole in the bone to receive a locking screw  106 . The threaded drill guide may also be used as a bone plate inserter instrument. Multiple threaded drill guides may be included in a kit or set of instruments. Inserting a bone plate may be a step in a method for using the disclosed apparatus. 
         [0112]    Referring to  FIGS. 19A and 19B , an olive wire may be used for temporary fixation in a hole in a bone plate, for example bone plate  902 . A laser mark on a drill may register with drill guide depth markings to indicate drilling depth ( FIG. 19A ). Drilling for a locking bone screw, and/or tapping for the locking bone screw, may be steps in a method for using the disclosed apparatus. 
         [0113]    Referring to  FIGS. 20A and 20B , a non-locking polyaxial drill guide may engage a hole in a bone plate, for example bone plate  902 , to accurately guide a drill to make a hole in the bone to receive a non-locking screw  108 . The plate bender may serve as a handle for the non-locking polyaxial drill guide ( FIG. 20A ). Drilling for a non-locking bone screw, and/or tapping for the non-locking bone screw, may be steps in a method for using the disclosed apparatus. 
         [0114]    Referring to  FIG. 21 , locking or non-locking screws may be used interchangeably in the screw holes of the bone plates after bone holes are drilled. A screw driver instrument transmits torque from a manual or power source to the screw to drive the screw into the bone and, if a locking screw, into the screw hole threads of the bone plate. While  FIG. 21  shows locking screws  106  placed proximally, but the procedure may progress from distal to proximal instead. Driving a screw into threaded engagement with the bone and, if a locking screw, with the screw hole threads of the bone plate, may be a step in a method for using the disclosed apparatus. 
         [0115]    Referring to  FIGS. 22A-22C , a staple drill guide may engage a pair of holes in a bone plate, for example bone plate  902 , to accurately guide a drill to make holes in the bone to receive a staple  104 . Drilling for a staple may be a step in a method for using the disclosed apparatus. The step of drilling for the staple may occur after one end (proximal or distal) of the plate is secured to bone. 
         [0116]    A staple inserter may hold the staple  104  for insertion ( FIG. 22B ). The staple inserter is described in at least one of the cross-referenced patent applications identified in paragraphs [0001]-[0005] of this application. For example, the staple  104  may be held with its legs forced into a parallel state for insertion. The staple inserter may engage the staple  104  strictly from a side of the staple opposite the side that faces the bone plate and bone portions, so that the staple  104  may be fully seated in the receiver while the staple inserter is attached to the staple  104 . After the staple has been inserted through the bone plate, removing the staple inserter may allow the staple legs to relax and attempt to resume the free state, in which the staple legs are acutely angled with respect to each other ( FIGS. 1A-1F ). Inserting a staple may be a step in a method for using the disclosed apparatus. 
         [0117]      FIG. 22C  shows the bone plate  902  and the staple  104  extending across the first Lisfranc joint (or first tarsometatarsal joint) of a human left foot. The staple extends through holes in the bone plate  902  so that each staple leg is on a different side of the joint. As the staple relaxes after the staple inserter is removed, the staple legs apply mechanical load or stress across the joint. As the staple  104  relaxes towards its free state shown in  FIGS. 1A-1F , the staple legs apply compressive load or stress across the joint. Conversely, a staple with divergent legs would apply tensile load or stress across the joint. 
         [0118]    Referring to  FIG. 23 , the bone plate  902 , staple  104 , locking screws  106 , and non-locking screws  108  are shown in the final implanted state across the first Lisfranc joint. It may be particularly advantageous to use locking screws  106  adjacent to one leg of the staple  104 , and non-locking screws  108  adjacent to the other leg of the staple  104 . This is illustrated in  FIG. 23 , where locking screws  106  are used in the medial cuneiform  18  and non-locking screws  108  are used in the first metatarsal  26 . However, an opposite arrangement is contemplated, with non-locking screws  108  are used in the medial cuneiform  18  and locking screws  106  are used in the first metatarsal  26 . 
         [0119]    Methods of using the disclosed apparatus may include any combination of the above mentioned steps, in any order. 
         [0120]    One example of a method of using the disclosed apparatus includes the steps of: inserting a bone plate adjacent to a first bone portion and a second bone portion, wherein a discontinuity separates the second bone portion from the first bone portion, wherein the bone plate extends across the discontinuity, wherein the bone plate includes at least four holes; locking a threaded drill guide to a first hole through the bone plate, wherein the first hole of the bone plate is adjacent to the first bone portion; drilling a first bone hole through the threaded drill guide into the first bone portion; driving a locking screw through the first hole of the bone plate into threaded engagement with the first bone hole and the first hole of the bone plate; engaging a staple drill guide with a second hole through the bone plate and a third hole through the bone plate, wherein the second hole of the bone plate is adjacent to the first bone portion, wherein the third hole of the bone plate is adjacent to the second bone portion; drilling a second bone hole through the staple drill guide into the first bone portion; drilling a third bone hole through the staple drill guide into the second bone portion; inserting a first leg of a staple through the second hole of the bone plate into engagement with the second bone hole and inserting a second leg of the staple through the third hole of the bone plate into engagement with the third bone hole, wherein the first leg of the staple is parallel to the second leg of the staple while the staple is inserted, wherein the first and second legs of the staple compress towards each other after the staple is inserted; engaging a non-locking polyaxial drill guide with a fourth hole through the bone plate, wherein the fourth hole of the bone plate is adjacent to the second bone portion; drilling a fourth bone hole through the non-locking polyaxial drill guide into the second bone portion; and driving a non-locking screw through the fourth hole of the bone plate into threaded engagement with the fourth bone hole and non-locking engagement with the fourth hole of the bone plate. 
         [0121]    The preceding method may also include the step of securing the staple to the bone plate. The staple may be secured to the bone plate with a set screw, a ductile tab, or a snap fit. The staple may be secured to the bone plate by a portion of the staple being molded within a portion of the bone plate. The staple may be secured to the bone plate by being integrally formed with the bone plate. 
         [0122]    Another example of a method of using the disclosed apparatus includes the steps of: inserting a bone plate adjacent to a first bone portion and a second bone portion, wherein a discontinuity separates the second bone portion from the first bone portion, wherein the bone plate extends across the discontinuity; drilling a first bone hole through a first hole through the bone plate into the first bone portion; drilling a second bone hole through a second hole through the bone plate into the second bone portion; inserting a leg of a first elbow peg through the first hole of the bone plate into engagement with the first bone hole and placing a head of the first elbow peg adjacent to the first hole of the bone plate; inserting a leg of a second elbow peg through the second hole of the bone plate into engagement with the second bone hole and placing a head of the second elbow peg adjacent to the second hole of the bone plate; driving a first bone screw through an aperture through the head of the first elbow peg and the first hole of the bone plate into threaded engagement with the first bone portion beside the leg of the first elbow peg; and driving a second bone screw through an aperture through the head of the second elbow peg and the second hole of the bone plate into threaded engagement with the second bone portion beside the leg of the second elbow peg. 
         [0123]    Yet another example of a method of using the disclosed apparatus includes the steps of: inserting a bone plate adjacent to a first bone portion and a second bone portion, wherein a discontinuity separates the second bone portion from the first bone portion, wherein the bone plate extends across the discontinuity; drilling a first bone hole through a first hole through the bone plate into the first bone portion; drilling a second bone hole through a second hole through the bone plate into the second bone portion; inserting a leg of a first elbow peg through the first hole of the bone plate into engagement with the first bone hole and placing a head of the first elbow peg over the first hole of the bone plate; inserting a leg of a second elbow peg through the second hole of the bone plate into engagement with the second bone hole and placing a head of the second elbow peg over the second hole of the bone plate; tightening a first set screw against the head of the first elbow peg; and tightening a second set screw against the head of the second elbow peg. 
         [0124]    Yet another example of a method of using the disclosed apparatus includes the steps of: inserting a bone plate adjacent to a first bone portion and a second bone portion, wherein a discontinuity separates the second bone portion from the first bone portion, wherein the bone plate extends across the discontinuity; drilling a first bone hole through a first hole through the bone plate into the first bone portion; drilling a second bone hole through a second hole through the bone plate into the second bone portion; inserting a leg of a first straight peg through the first hole of the bone plate into engagement with the first bone hole and placing a head of the first straight peg in the first hole of the bone plate; inserting a leg of a second straight peg through the second hole of the bone plate into engagement with the second bone hole and placing a head of the second straight peg in the second hole of the bone plate; tightening a first set screw against the head of the first straight peg; and tightening a second set screw against the head of the second straight peg. 
         [0125]    The preceding method may also include the step of rotating the first and/or second straight pegs to position the leg(s) in desired orientation(s) relative to the bone plate before tightening the set screws. 
         [0126]    Any methods disclosed herein includes one or more steps or actions for performing the described method. The method steps and/or actions may be interchanged with one another. In other words, unless a specific order of steps or actions is required for proper operation of the embodiment, the order and/or use of specific steps and/or actions may be modified. 
         [0127]    Reference throughout this specification to “an embodiment” or “the embodiment” means that a particular feature, structure or characteristic described in connection with that embodiment is included in at least one embodiment. Thus, the quoted phrases, or variations thereof, as recited throughout this specification are not necessarily all referring to the same embodiment. 
         [0128]    Similarly, it should be appreciated that in the above description of embodiments, various features are sometimes grouped together in a single embodiment, Figure, or description thereof for the purpose of streamlining the disclosure. This method of disclosure, however, is not to be interpreted as reflecting an intention that any claim require more features than those expressly recited in that claim. Rather, as the following claims reflect, inventive aspects lie in a combination of fewer than all features of any single foregoing disclosed embodiment. Thus, the claims following this Detailed Description are hereby expressly incorporated into this Detailed Description, with each claim standing on its own as a separate embodiment. This disclosure includes all permutations of the independent claims with their dependent claims. 
         [0129]    Recitation in the claims of the term “first” with respect to a feature or element does not necessarily imply the existence of a second or additional such feature or element. Elements recited in means-plus-function format are intended to be construed in accordance with 35 U.S.C. §112 Para. 6. It will be apparent to those having skill in the art that changes may be made to the details of the above-described embodiments without departing from the underlying principles of the technology. 
         [0130]    While specific embodiments and applications of the present technology have been illustrated and described, it is to be understood that the technology is not limited to the precise configuration and components disclosed herein. Various modifications, changes, and variations which will be apparent to those skilled in the art may be made in the arrangement, operation, and details of the methods and systems of the present technology disclosed herein without departing from the spirit and scope of the technology.