Patent Publication Number: US-2022211368-A1

Title: Implant inserter

Description:
PRIORITY CLAIM 
     The present application is a continuation of U.S. application Ser. No. 16/076,607, filed Aug. 8, 2018, now U.S. Pat. No. 11,284,886, issued Mar. 29, 2022, which is a National Phase of International Application No. PCT/US2017/016931, filed Feb. 8, 2017, which claims priority to U.S. Provisional Application Nos. 62/292,823, filed Feb. 8, 2016; and 62/355,276, filed Jun. 27, 2016. The entire contents of each are incorporated herein by reference and relied upon. 
    
    
     TECHNICAL FIELD 
     The present disclosure is made in the context of an inserter for a compression bone staple. However, one of skill in the art will appreciate that the disclosed technology is broadly applicable outside this context to implants that are movable between a free state and an elastically deformed state. 
     BACKGROUND 
     Staples of various designs are used for fixation in surgical procedures. In such procedures, two human body parts, e.g. bones, on either side of an interface, are joined together by drilling parallel holes in the body parts on either side of the interface and inserting the legs of a staple into the holes. The legs of the staple are substantially parallel to each other when they are inserted into the holes, but the staple is constructed so that after the staple has been implanted, the ends of the legs converge forcefully towards each other, and thus substantially immobilize the interface. Continuing compression of the body parts has additional benefits, for example continuing compression of bones at the interface promotes bone regrowth. The known surgical staples are composed of a shape memory metal (e.g. a nickel titanium alloy) or an elastic polymeric material, for example polyetherether ketone (PEEK). The known procedures for inserting staples into bones are complicated and expensive. 
     SUMMARY 
     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 systems with implants and inserters. 
     In an aspect of the technology, a system includes: an implant including a body, a left retainer, and a right retainer, wherein the body extends between a left end and a right end to establish a longitudinal direction of the body, wherein the left retainer protrudes from the left end of the body, wherein the right retainer protrudes from the right end of the body; and an inserter releasably connectable to the implant, the inserter including a left connection, a right connection, and an intermediate connection between the left and right connections; wherein when the inserter is connected to the implant, the left connection engages the left retainer, the right connection engages the right retainer, and the intermediate connection is adjacent to the body; wherein when the inserter is connected to the implant, the system is movable between a free state and an actuated state, wherein in the free state the body is undeformed by the inserter, wherein in the actuated state the body is elastically deformed by pressure from the intermediate connection acting against resistance from the left and right connections. 
     Various embodiments of this aspect of the technology may include any or all of the following characteristics. The left and right retainers extend along the longitudinal direction of the body. The body extends between a front side and an opposite back side to establish a front to back direction of the body, wherein the left and right retainers extend along the front to back direction. The body extends between a body lower surface and an opposite body upper surface, wherein the left retainer extends between a left lower surface and an opposite left upper surface, wherein the right retainer extends between a right lower surface and an opposite right upper surface, wherein the body upper surface and the left and right lower surfaces are on the same side of the body lower surface. When the inserter is connected to the implant, the body upper surface and the entire inserter are on the same side of the body lower surface. The body lower surface is a bone facing surface. The left connection is a left jaw, wherein the right connection is a right jaw, wherein the intermediate connection is a junction; wherein when the inserter is connected to the implant, the left jaw engages under the left retainer, the right jaw engages under the right retainer, and the junction is adjacent to the body. 
     In another aspect of the technology, a system includes: an implant including a body, a left retainer, and a right retainer, wherein the body includes a bone contacting surface, wherein the body extends between a left end and a right end to establish a longitudinal direction of the body, wherein the left retainer protrudes from the left end of the body, wherein the right retainer protrudes from the right end of the body; and an inserter releasably connectable to the implant, the inserter including a left connection, a right connection, and an intermediate connection between the left and right connections; wherein when the inserter is connected to the implant, the left connection engages the left retainer, the right connection engages the right retainer, and the intermediate connection is adjacent to the body, wherein the left and right retainers and the entire inserter are all on the same side of the bone contacting surface; wherein when the inserter is connected to the implant, the system is movable between a free state and an actuated state, wherein in the free state the body is undeformed by the inserter, wherein in the actuated state the body is elastically deformed by pressure from the intermediate connection acting against resistance from the left and right connections. 
     Various embodiments of this aspect of the technology may include any or all of the following characteristics. The left and right retainers extend along the longitudinal direction of the body. The body extends between a front side and an opposite back side to establish a front to back direction of the body, wherein the left and right retainers extend along the front to back direction. The body includes an upper surface opposite the bone contacting surface, wherein the left retainer extends between a left lower surface and an opposite left upper surface, wherein the right retainer extends between a right lower surface and an opposite right upper surface, wherein the upper surface of the body and the left and right lower surfaces are on the same side of the bone contacting surface. The left connection is a left hook, wherein the right connection is a right hook, wherein the intermediate connection is a junction; wherein when the inserter is connected to the implant, the left hook engages under the left retainer, the right hook engages under the right retainer, and the junction is adjacent to the body. 
     In yet another aspect of the technology, a system includes: a bone staple including a bridge, a left leg, a right leg, a left retainer, and a right retainer, wherein the bridge extends between a left end and a right end to establish a longitudinal direction of the bridge, wherein the left leg includes a left proximal end that is attached to the left end of the bridge, wherein the left leg terminates in a left distal end opposite the bridge, wherein the right leg includes a right proximal end that is attached to the right end of the bridge, wherein the right leg terminates in a right distal end opposite the bridge, wherein the right leg extends beside the left leg, wherein the left and right proximal ends are separated by a first distance, wherein the left retainer is attached to and extends from the left end of the bridge, wherein the right retainer is attached to and extends from the right end of the bridge, wherein the bone staple is movable between a staple free state and an elastically deformed state, wherein when the bone staple is in the staple free state, the staple is undeformed and the left and right distal ends are separated by a second distance which is less than the first distance, wherein when the bone staple is in the elastically deformed state, the left and right distal ends are separated by a third distance which is greater than the second distance; and an inserter releasably connectable to the bone staple, the inserter including a left connector, a right connector, and an intermediate connector, wherein the left connector faces the right connector, wherein the intermediate connector is between the left and right connectors, wherein the inserter is movable between an inserter free state and an actuated state; wherein when the inserter in the inserter free state is connected to the bone staple in the staple free state, the left connector engages the left retainer, the right connector engages the right retainer, and the intermediate connector is adjacent to the bridge, between the left and right ends of the bridge, and opposite the left and right legs; wherein when the inserter in the actuated state is connected to the bone staple in the elastically deformed state, the left connector engages the left retainer, the right connector engages the right retainer, and the intermediate connector presses against the bridge between the left and right ends of the bridge and opposite the left and right legs. 
     Various embodiments of this aspect of the technology may include any or all of the following characteristics. The left and right retainers extend along the longitudinal direction. 
     The bridge extends between a front side and an opposite back side to establish a front to back direction of the bridge, wherein the left and right retainers extend along the front to back direction. 
     The bridge extends between a bridge lower surface and an opposite bridge upper surface, wherein the left retainer extends between a left lower surface and an opposite left upper surface, wherein the right retainer extends between a right lower surface and an opposite right upper surface, wherein the bridge upper surface and the left and right lower surfaces are on the same side of the bridge lower surface. When the inserter is connected to the bone staple, the bridge upper surface and the entire inserter are on the same side of the bridge lower surface. The bridge lower surface is a bone contacting surface. The third distance is equal to the first distance. The third distance is greater than the first distance. 
     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 
       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: 
         FIG. 1A  is a detail perspective view of a distal portion of a system with an implant coupled to an inserter;  FIG. 1B  is a detail side view of a distal portion of the system of  FIG. 1A ; and  FIG. 1C  is a perspective view of the system of  FIG. 1A ; 
         FIG. 2A  is a front view of an implant for use in the system of  FIG. 1A ; and  FIG. 2B  is a perspective view of the implant of  FIG. 2A ; 
         FIG. 3A  is a front view of another implant for use in the system of  FIG. 1A ; and  FIG. 3B  is a perspective view of the implant of  FIG. 2A ; 
         FIG. 4A  is an exploded perspective view of the inserter of  FIG. 1A ; and  FIG. 4B  is another exploded perspective view of the inserter of  FIG. 1A  from a different direction; 
         FIG. 5A  is a perspective view of another system with yet another implant coupled to another inserter; and  FIG. 5B  is a detail front view of a distal portion of the system of  FIG. 5A ; 
         FIG. 6A  is a detail perspective view of a distal portion of a body of the inserter of  FIG. 5A ; and  FIG. 6B  is another detail perspective view of the distal portion of the body of  FIG. 6A  from a different direction; 
         FIG. 7  is a perspective view of a control member of the inserter of  FIG. 5A ; 
         FIG. 8  is a perspective view of left and right capture members of the inserter of  FIG. 5A ; and 
         FIG. 9A  is a perspective view of the implant of  FIG. 5A ;  FIG. 9B  is an exploded perspective view of the implant of  FIG. 5A ;  FIG. 9C  is a front view of the implant of  FIG. 5A ; and  FIG. 9D  is a side view of the implant of  FIG. 5A . 
     
    
    
     DETAILED DESCRIPTION 
     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. 
     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. 
     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. 
     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. The sagittal, coronal, and transverse planes are mutually perpendicular. 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. 
     Referring to  FIGS. 1A-1C , a system  1100  includes an implant  1200  and an inserter  1300 . The system  1100  may be referred to as a delivery device and the inserter  1300  may be referred to as a delivery member. The implant  1200  is shown coupled to the inserter  1300 , with the implant and inserter in their free states. The illustrated implant  1200  is a compression bone staple. 
     Referring to  FIGS. 2A-2B , the implant  1200  includes bone engaging members  1202 ,  1204  which may be integral to an implant bridge  1206 , also referred to as an implant body. The bone engaging members  1202 ,  1204  may be referred to as legs. The bone engaging member  1202  extends from a left end  1230  of the implant bridge  1206  and the bone engaging member  1204  extends from an opposite right end  1232  of the implant bridge  1206 . Bone engaging member  1202  has a proximal end  1234  attached to the left end  1230  of the implant bridge  1206  and an opposite distal end  1236  which is a free end. Bone engaging member  1204  has a proximal end  1238  attached to the right end  1232  of the implant bridge  1206  and an opposite distal end  1240  which is a free end. Implant bridge  1206  has an upper surface  1208 , a lower surface  1210 , a front surface  1209 , and an opposite back surface (not shown). The lower surface  1210  may be referred to as a bone facing surface. Bone engaging member  1202  extends from the lower surface  1210  beside bone engaging member  1204 . The bone engaging members  1202 ,  1204  may have features  1212  that may improve bone purchase or improve pull out strength of the implant  1200  from bone or soft tissue. The features  1212  may be referred to as teeth or serrations. The features  1212  are shown on facing sides of the bone engaging members  1202 ,  1204  but may be on any or all sides of the bone engaging members. The implant  1200  may have projections or other connecting means  1214 ,  1216  for connection with a means of insertion, such as inserter  1300 . The connecting means  1214 ,  1216  may be referred to as tabs, ears, protrusions, retainers, wings, or retaining members. The connecting means  1214 ,  1216  are shown extending sideways outwardly from the ends  1230 ,  1232  of the bridge  1206 , respectively, along a longitudinal direction established by the bridge. However, in other examples, the connecting means may extend outwardly from the ends  1230 ,  1232  of the bridge  1206 , respectively, along a front to back direction. These examples may include four connecting means: left front, left back, right front, and right back. The connecting means  1214 ,  1216  may have lower surfaces  1218 ,  1220  respectively that may releasably engage with a means of insertion that may allow the inserter  1300  or other means of insertion to be side loading, top loading or pivotably loaded. For example, the inserter  1300  may be described as side loading or pivotably loading. The lower surfaces  1218 ,  1220  may be referred to as bone facing surfaces. Referring to  FIG. 2A , the lower surfaces  1218 ,  1220  are proximally spaced apart from, or proximally offset from, from the lower surface  1210 . The dashed extension lines  1210 ′,  1210 ″ in  FIG. 2A  show the level) of the lower surface  1210  versus the lower surfaces  1218 ,  1220 . 
     The means of insertion may maintain a one piece implant in a first configuration thereby allowing a second implant configuration once the implant is disassembled from the implant. The first configuration may be an elastically deformed state, for example an insertion state. The second configuration may be a free state or an implanted state. The means of insertion may utilize features similar to connecting means  1214  and  1216  in combination with other surfaces such as top surface  1208 . This combination of means of insertion may be used to maintain one or more features or arras or projections in a particular configuration. This combination of means of insertion may create a bending modality, such as a three point or four point bend, to maintain a specific implant configuration or combination of configurations. A combination of surfaces and means of insertion, such as connecting means  1214 , may be used on the entire implant or portions of an implant to create or maintain a particular configuration of an implant. For example, a tab such as  1214  and top surface, such as  1208  may be used to maintain one side of an implant or one arm of an implant in a particular configuration. When disassembled, that arm may have a configuration that is different from or the same as the configuration of the rest of the implant. 
     Referring to  FIGS. 2A-2B , the implant  1200  is shown uncoupled from the inserter  1300 . The implant  1200  is in a free state, or relaxed state, which is the shape of the implant  1200  when no external forces are acting upon the implant  1200 , other than gravity; the implant  1200  experiences no elastic or plastic deflection or deformation. In the free state, the bone engaging members  1202 ,  1204  converge as they extend away from the bridge  1206  so that the distal ends  1236 ,  1240  are closer together than are the proximal ends  1234 ,  1238 . An angle  1222  is formed between the converging bone engaging members  1202 ,  1204  in the free state. The angle  1222  opens toward the bridge  1206 . The angle  1222  may be referred to as a free state angle. 
     Referring to  FIGS. 3A-3B , another implant  1250  may be included in the system  1100  instead of implant  1200 . The implant  1250  may be identical to the implant embodiment  2200  described in International Patent Application Serial No. PCT/US2015/039551. 
     Referring to  FIGS. 3A-3B , the implant  1250  includes bone engaging members  1252 ,  1254  which may be integral to an implant bridge  1256 , also referred to as an implant body. The bone engaging members  1252 ,  1254  may be referred to as legs. The bone engaging member  1252  extends from a left end  1280  of the implant bridge  1256  and the bone engaging member  1254  extends from an opposite right end  1282  of the implant bridge  1256 . Bone engaging member  1252  has a proximal end  1284  attached to the left end  1280  of the implant bridge  1256  and an opposite distal end  1286  which is a free end. Bone engaging member  1254  has a proximal end  1288  attached to the right end  1282  of the implant bridge  1256  and an opposite distal end  1290  which is a free end. Implant bridge  1256  has an upper surface  1258 , a lower surface  1260 , a front surface  1259 , and a back surface (not shown). The lower surface  1260  may be referred to as a bone facing surface. Bone engaging member  1252  extends from the lower surface  1260  beside bone engaging member  1254 . The bone engaging members  1252 ,  1254  may have features  1262  that may improve bone purchase or improve pull out strength of the implant  1250  from bone or soft tissue. The features  1262  may be referred to as teeth or serrations. The features  1262  are shown on facing sides of the bone engaging members  1252 ,  1254  but may be on any or all sides of the bone engaging members. The implant  1250  may have projections or other connecting means  1264 ,  1266  for connection with a means of insertion, such as inserter  1300 . The connecting means  1264 ,  1266  may be referred to as tabs, ears, protrusions, retainers, wings, or retaining members. The connecting means  1264 ,  1266  are shown extending sideways outwardly from the ends  1280 ,  1282  of the bridge  1256 , respectively, along a longitudinal direction established by the bridge. However, in other examples, the connecting means may extend outwardly from the ends  1280 ,  1282  of the bridge  1256 , respectively, along a front to back direction. These examples may include four connecting means: left front, left back, right front, and right back. The connecting means  1264 ,  1266  may have lower surfaces  1268 ,  1270  respectively that may releasably engage with a means of insertion that may allow the inserter  1300  or other means of insertion to be side loading, top loading or pivotably loaded. For example, the inserter  1300  may be described as side loading or pivotably loading. The lower surfaces  1268 ,  1270  may be referred to as bone facing surfaces. Referring to  FIG. 3A , the lower surfaces  1268 ,  1270  are proximally spaced apart from, or proximally offset from, from the lower surface  1260 . The dashed extension lines  1260 ′,  1260 ″ in  FIG. 3A  show the level) of the lower surface  1260  versus the lower surfaces  1268 ,  1270 . 
     The means of insertion may maintain a one piece implant in a first configuration thereby allowing a second implant configuration once the implant is disassembled from the implant. The first configuration may be an elastically deformed state, for example an insertion state. The second configuration may be a free state or an implanted state. The means of insertion may utilize features similar to connecting means  1264  and  1266  in combination with other surfaces such as top surface  1258 . This combination of means of insertion may be used to maintain one or more features or arras or projections in a particular configuration. This combination of means of insertion may create a bending modality, such as a three point or four point bend, to maintain a specific implant configuration or combination of configurations. A combination of surfaces and means of insertion, such as connecting means  1264 , may be used on the entire implant or portions of an implant to create or maintain a particular configuration of an implant. For example, a tab such as  1264  and top surface, such as  1258  may be used to maintain one side of an implant or one arm of an implant in a particular configuration. When disassembled, that arm may have a configuration that is different from or the same as the configuration of the rest of the implant. 
     Referring to  FIGS. 3A-3B , the implant  1250  is shown uncoupled from the inserter  1300 . The implant  1250  is in a free state, or relaxed state, which is the shape of the implant  1250  when no external forces are acting upon the implant  1250 , other than gravity; the implant  1250  experiences no elastic or plastic deflection or deformation. In the free state, the bone engaging members  1252 ,  1254  converge as they extend away from the bridge  1256  so that the distal ends  1286 ,  1290  are closer together than are the proximal ends  1284 ,  1288 . An angle  1272  is formed between the converging bone engaging members  1252 ,  1254  in the free state. The angle  1272  opens toward the bridge  1256 . The angle  1272  may be referred to as a free state angle. 
     The implants  1200 ,  1250  may be fabricated from any suitably elastic biocompatible material. The implants  1200 ,  1250  are preferably made of metal or polymer, preferably nitinol or polyetheretherketone (PEEK). 
     Referring to  FIGS. 1A-1C and 4A-4B , the inserter  1300  includes a body  1400 , a first arm  1500 , and a second arm  1600 . The first and second arras  1500 ,  1600  are separate component parts in this example, however the first and second arras  1500 ,  1600  may optionally be integrally formed with the body  1400  as a single part. 
     The illustrated inserter  1300  has a first plane of symmetry along plane  1  of  FIG. 1A  and a second plane of symmetry along plane  2  of  FIG. 1B , which is shown edge on and is thus represented by a line  2 . The first and second planes of symmetry are perpendicular to each other. The first plane of symmetry divides the inserter  1300  into left and right halves. The second plane of symmetry divides the inserter  1300  into front and back halves. The first and second planes of symmetry also apply to the implant  200  and the body  1400 . However, in other examples, the inserter  1300  and/or implant  200  may have only one plane of symmetry, or no plane of symmetry so that they are asymmetric. 
     The body  1400  is an elongated part that extends between a distal end  1402  and an opposite proximal end  1404 . The distal end  1402  may be referred to as a working portion and the proximal end  1404  may be referred to as a handle. The body  1400  has a front surface  1406 , an opposite back surface  1408 , a left side  1410 , and an opposite right side  1412 . The body  1400  includes a left half  1418  and a right half  1420 . The left and right halves  1418 ,  1420  may be mirror images of each other, except for the clip features discussed below. The left half  1418  has a distal portion  1422  and a proximal portion  1424 . The right half  1420  has a distal portion  1426  and a proximal portion  1428 . 
     The left and right halves  1418 ,  1420  may be joined together by an optional flex bridge  1432 , which biases the proximal portions  1424 ,  1428  away from each other. The flexible bridge  1432  is shown with a bend to enhance flexibility of the flex bridge. The flex bridge  1432  may be replaced by another type of biasing element, such as a spring. The flex bridge  1432  is shown integral with the body  1400 , but the flex bridge may be a separate component part, for example a metal ribbon coupled to the left and right halves  1418 ,  1420 . 
     The distal portions  1422 ,  1426  may be joined together at a central junction  1430 . The junction  1430  may be referred to as an intermediate connection. The body  1400  includes a left arm recess  1414  and a right arm recess  1416 . The left arm recess  1414  extends into the left side  1410  at the distal end  1402 . The right arm recess  1416  extends into the right side  1412  at the distal end  1402 . The right arm recess  1416  is a mirror image of the left arm recess  1414  in this example. When the first and second arras  1500 ,  1600  are integrally formed with the body  1400 , the arm recesses  1414 ,  1416  are not present. 
     The proximal portions  1424 ,  1428  may be enlarged and rounded to form comfortable handles for a user to grasp. The left proximal portion  1424  may optionally include a first clip feature  1434  and the right proximal portion  1428  may optionally include a second clip feature  1436 . The first and second clip features  1434 ,  1436  cooperate to releasably hold the left proximal portion  1424  at a fixed distance from the right proximal portion  1428 . The first clip feature  1434  includes a recess  1438  that receives and releasably retains a tooth  1440  included in the second clip feature  1436 . Multiple recesses and/or teeth may be included to provide multiple different fixed distances between the proximal portions  1424 ,  1428 . The engagement between the recess  1438  and the tooth  1440  may be released by actuating a lever  1442  or other control feature. The lever  1442  is shown included in the second clip feature  1436  but can instead be included in the first clip feature  1436 . The first and second clip features  1434 ,  1436  may be integral with the body  1400  as shown, or optionally may be separate component parts coupled to the left and right halves  1418 ,  1420 . The clip features  1434 ,  1436  shown may be replaced with a ratchet mechanism or other releasable retention mechanism. 
     The first arm  1500  is an elongated part that extends between a distal end  1502  and an opposite proximal end  1504 . The first arm  1500  has a front surface  1506 , an opposite back surface  1508 , an outer side  1510 , and an opposite inner side  1512 . The distal end  1502  may be referred to as a jaw or a connection. The distal end  1502  terminates in a small hook  1520  that protrudes from the inner side  1512 . The hook  1520  may be referred to as a formation, a clip (distinct from the first and second clip features  1434 ,  1436 ), a connection, or a capture member. 
     The second arm  1600  in this example is identical to the first arm  1500 . However, to differentiate the two parts, the second arm is given reference number series  1600 . 
     The second arm  1600  is an elongated part that extends between a distal end  1602  and an opposite proximal end  1604 . The second arm  1600  has a front surface  1606 , an opposite back surface  1608 , an outer side  1610 , and an opposite inner side  1612 . The distal end  1602  may be referred to as a jaw or a connection. The distal end  1602  terminates in a small hook  1620  that protrudes from the inner side  1612 . The hook  1620  may be referred to as a formation, a clip (distinct from the first and second clip features  1434 ,  1436 ), a connection, or a capture member. 
     The body  1400  may be fabricated from any suitable material. The body  1400  is preferably made of metal or polymer, preferably stainless steel or polycarbonate. The first and second arras  1500 ,  1600  may be fabricated from any suitable material. The first and second arras  1500 ,  1600  are preferably made of metal or polymer, preferably stainless steel or polycarbonate. In one example, the body  1400  is made of a polymer and the first and second arras  1500 ,  1600  are made of hardened steel. In another example, the body  1400  and the arras  1500 ,  1600  are integrally formed as a single part made of metal, preferably an elastic metal such as spring steel. In yet another example, the body  1400  and the arras  1500 ,  1600  are integrally formed as a single part made of polymer. 
     The first arm  1500  is coupled to the body  1400  so that the distal end  1402  and the distal end  1502  face the same direction, the front surface  1406  and the front surface  1506  face the same direction, the back surface  1408  and the back surface  1508  face the same direction, and the inner side  1512  faces into the left arm recess  1414 . The second arm  1600  is coupled to the body  1400  so that the distal end  1402  and the distal end  1602  face the same direction, the front surface  1406  and the back surface  1608  face the same direction, the back surface  1408  and the front surface  1606  face the same direction, and the inner side  1612  faces into the right arm recess  1416 . When the first and second arras  1500 ,  1600  are coupled to the body  1400 , the concave sides of the hooks  1520 ,  1620  face each other. The first and second arras  1500 ,  1600  may be coupled to the body  1400  by screws, pins, rivets, press fit, dovetail connection, adhesive, over molding, insert molding, or other means. Preferably, the first and second arras  1500 ,  1600  are rigidly coupled to the body  1400 , and are removable for cleaning or replacement. As mentioned previously, the first and second arms  1500 ,  1600  may optionally be integrally formed with the body  1400  as a single part. 
     When the inserter  1300  is fully assembled as shown in  FIG. 1C , as the proximal portions  1424 ,  1428  are moved toward each other, the left and right halves  1418 ,  1420  pivot about the central junction  1430  so that the hooks  1520 ,  1620  rotate proximally relative to the central junction  1430 , the optional flex bridge  1432  deforms so that the proximal bend becomes more pronounced, and, if present, the first and second clip features  1434 ,  1436  move towards each other so that eventually the tooth  1440  is received in the recess  1438 . The flex bridge preferably deforms elastically. When the proximal portions  1424 ,  1428  are pressed inwardly toward each other against the resistance of the flex bridge  1432 , the inserter  1300  is in a compressed state, also referred to as an actuated state. When the tooth  1440  is received in the recess  1438 , the inserter  1300  is in a locked state. If there are multiple recesses  1438  and/or teeth  1440 , then when the first tooth/recess are engaged, the inserter  1300  is in a first locked state; when the second tooth/recess are engaged, the inserter  1300  is in a second locked state; and so on for third, fourth, or higher locked states. If present, the first and second clip features  1434 ,  1436  may be disengaged or released by pressing the lever  1442  toward the right proximal portion  1428 . As the proximal portions  1424 ,  1428  are moved away from each other, the left and right halves  1418 ,  1420  pivot about the central junction  1430  so that the hooks  1520 ,  1620  rotate distally relative to the central junction  1430 , the flex bridge  1432  relaxes so that the proximal bend becomes less pronounced, and, if present, the first and second clip features  1434 ,  1436  move away from each other. The proximal portions  1424 ,  1428  may be biased by the flex bridge  1432  to move away from each other automatically as soon as inward pressure on the proximal portions  1424 ,  1428  is released, or, if present, as soon as the first and second clip features  1434 ,  1436  are disengaged or released. When the first and second clip features  1434 ,  1436  are disengaged or released, the inserter  1300  is in an unlocked state. When the flex bridge  1432  has relaxed to its free state, the inserter  1300  is in a free state. 
     Referring to  FIG. 1A-1C , the implant  1200  is shown coupled or connected to the inserter  1300 . The implant  1200  and inserter  1300  are each in the free state. The implant  1200  is coupled to the inserter  1300  by engaging the hooks  1520 ,  1620  of the first and second arras  1500 ,  1600  under the connecting means  1214 ,  1216  of the implant  1200 , for example by sliding or twisting. The inserter  1300  is secured to, for example, clips over, around, and/or underneath the retaining members of the implant  1200 . With the bridge  1206  parallel to the second plane of symmetry as shown in  FIGS. 1A-1C , the connecting means  1214 ,  1216  and the bridge  1206  may slide straight into engagement with the hooks  1520 ,  1620  from the front or back of the inserter  1300 . Alternately, the hooks  1520 ,  1620  may slide under the connecting means  1214 ,  1216  along the longitudinal direction established by the bridge. Alternately, with the bridge parallel to the first plane of symmetry, the middle of the bridge  1206  may be placed adjacent to the central junction  1430  and the implant  1200  may be twisted clockwise or counterclockwise relative to the inserter  1300  to rotate the connecting means  1214 ,  1216  into engagement with the hooks  1520 ,  1620 . When the implant  1200  is coupled to the inserter  1300 , the distal) portions  1422 ,  1426  of the body  1400  extend along and above the bridge  1206  of the implant  1200  so that the central junction  1430  is adjacent to a middle portion of the bridge  1206 . When the implant  1200  and inserter  1300  are each in the free state, the central junction  1430  is separated from the bridge  1206  by a gap  1431  ( FIG. 1A ). The proximal portions  1424 ,  1428  extend away from the bridge  1206  generally opposite the bone engaging members  1202 ,  1204 . The implant  1200  may be pre-loaded on the inserter  1300  in a package, such as a sterile package, with the implant  1200  in the free state. The implant  1200  is also decoupled or disconnected from the inserter  1300  by disengaging the hooks  1520 ,  1620  of the first and second arras  1500 ,  1600  from under the connecting means  1214 ,  1216  of the implant  1200  by sliding or twisting. The connection between the inserter  1300  and the implant  1200  may be ruptured by changing the shape of the inserter  1300  and/or by twisting the inserter  1300  relative to the retaining members. The retaining members remain in place with the implant  1200  after the inserter  1300  has been removed. 
     Referring to  FIGS. 1A, 1C, and 2A , when the implant  1200  is coupled to the inserter  1300 , the hooks  1520 ,  1620  may not extend below the lower surface  1210  of the bridge  1206 , due at least in part to the arrangement of the lower surfaces  1218 ,  1220  of the connecting means  1214 ,  1216  being proximally offset from the lower surface  1210  of the bridge  1206 . Instead, the hooks  1520 ,  1620  may be even with, or flush with, the lower surface  1210 ; or proximally spaced apart from, or proximally offset from, the lower surface  1210 . More specifically, the distal-most aspect of each hook  1520 ,  1620  may be at the same level as, or proximal to, the lower surface  1210 . This is significant because the lower surface  1210  may contact a bone surface when the implant  1200  is implanted. In examples where the hooks  1520 ,  1620  are flush with, or proximally offset from, the lower surface, the implant  1200  may be fully seated against the bone surface without interference from the hooks  1520 ,  1620  against the bone surface. Referring to  FIG. 2A , the dashed extension lines  1210 ′,  1210 ″ show the level of the lower surface  1210  when the implant  1200  is in the free state.  FIGS. 1A, 1C, and 2A  also illustrate that the bridge  1206 , connecting means  1214 ,  1216 , and the entire inserter  1300  are located on the proximal side of the lower surface  1210 . 
     Referring to  FIGS. 1A-1C , when the implant  1200  is coupled to the inserter  1300 , the inserter  1300  may be actuated to urge the implant  1200  into an elastically deformed state. The inserter  1300  may be moved from the free state to the compressed state, or the locked state if the first and second clip features  1434 ,  1436  are present (or to a first, second, or higher locked state if multiple locked states are enabled by the design of the inserter  1300 ). As the inserter  1300  moves from the free state to the compressed state or the locked state, the hooks  1520 ,  1620  rotate proximally relative to the central junction  1430  and the gap  1431  ( FIG. 1A ) decreases until the central junction  1430  contacts the upper surface  1208  of the bridge  1206  and presses the bridge distally against the resistance of the hooks  1520 ,  1620  under the connecting means  1214 ,  1216 . In the example, the central junction  1430  contacts and pushes against the middle of the upper surface  1208  to put the bridge into three point bending. However, the central junction  1430  may be designed to contact and push against a different location along the upper surface  1208 , or multiple locations. A central junction designed to contact two separate locations along the upper surface  1208  would put the bridge into four point bending, for example. While in the illustrated example, the proximal portions  1424 ,  1428  are moved toward each other to actuate the inserter  1300 , in other examples the proximal portions  1424 ,  1428  may be moved away from each other, or otherwise moved relative to each other, to actuate the inserter  1300 . 
     Actuating the inserter  1300  from the free state to the compressed state or the locked state puts the implant  1200  into an elastically deformed state in which the distal ends  1236 ,  1240  of the bone engaging members  1202 ,  1204  are farther away from each other than they are in the implant free state. The inserter  1300  may urge the implant  1200  into a first elastically deformed state in which the distal ends  1236 ,  1240  are farther apart than they are in the implant free state, but not as far apart as the proximal ends  1234 ,  1238 , so that the bone engaging members  1202 ,  1204  still converge slightly; a second elastically deformed state in which the distal ends  1236 ,  1240  and the proximal ends  1234 ,  1238  are the same distance apart, so that the bone engaging members  1202 ,  1204  are parallel, at least to the unaided eye; or a third elastically deformed state in which the distal ends  1236 ,  1240  are farther apart than are the proximal ends  1234 ,  1238 , so that the bone engaging members  1202 ,  1204  diverge. 
     As the inserter  1300  moves from the compressed state or the locked state to the free state, the hooks  1520 ,  1620  rotate distally relative to the central junction  1430  and the central junction  1430  moves away from the upper surface  1208  of the bridge  1206  to allow the bridge  1206  and the entire implant  1200  to relax toward the implant free state. 
     The implant  1200  may be decoupled or disconnected from the inserter  1300  when the implant  1200  is in the free state or an elastically deformed state. The inserter  1300  may be decoupled or disconnected from the implant  1200  when the inserter  1300  is in the free state, the unlocked state, the compressed state, or a locked state if the first and second clip features  1434 ,  1436  are present. 
     A surgical method for stabilizing first and second bone fragments may include any or all of the following steps in any order: preparing a first hole in the first bone fragment; inserting a temporary fixation pin in the first hole; preparing a second hole in the second bone fragment; determining an implant size corresponding to the first and second holes; selecting the proper size implant  1200 ; coupling the selected implant  1200  to the inserter  1300 , the implant  1200  in the free state; urging the implant  1200  into an elastically deformed state; inserting the bone engaging member  1202  into the first hole and the bone engaging member  1204  into the second hole; seating the lower surface  1210  against a surface of the first or second bone fragment; allowing the implant  1200  to relax toward the implant free state; and decoupling the inserter  1300  from the implant  1200 . Allowing the implant  1200  to relax toward the implant free state may comprise releasing inward pressure on the proximal portions  1424 ,  1428 . Optionally, allowing the implant  1200  to relax toward the implant free state may comprise disengaging the first and second clip features  1434 ,  1436 . 
     Referring to  FIGS. 5A-9D , another system  2100  includes an implant  2200  and an inserter  2300 . The system  2100  may be referred to as a delivery device and the inserter  2300  may be referred to as a delivery member. In  FIGS. 5A-5B , the implant  2200  is shown coupled to the inserter  2300 , with the implant  2200  and inserter  2300  in their free states. The illustrated implant  2200  is a compression bone staple. 
     Referring to  FIGS. 5A-5B and 9A-9D , the implant  2200  includes bone engaging members  2202 ,  2204  which may be integral to an implant bridge  2206 , also referred to as an implant body. The bone engaging members  2202 ,  2204  may be referred to as legs. The bone engaging member  2202  extends from a left end  2230  of the implant bridge  2206  and the bone engaging member  2204  extends from an opposite right end  2232  of the implant bridge  2206 . Bone engaging member  2202  has a proximal end  2234  attached to the left end  2230  of the implant bridge  2206  and an opposite distal end  2236  which is a free end. Bone engaging member  2204  has a proximal end  2238  attached to the right end  2232  of the implant bridge  2206  and an opposite distal end  2240  which is a free end. Implant bridge  2206  has an upper surface  2208 , a lower surface  2210 , a front surface  2209 , and a back surface  2211 . The lower surface  2210  may be referred to as a bone facing surface. Bone engaging member  2202  extends from the lower surface  2210  beside bone engaging member  2204 . The bone engaging members  2202 ,  2204  may have features  2212  that may improve bone purchase or improve pull out strength of the implant  2200  from bone or soft tissue. The features  2212  may be referred to as teeth or serrations. The features  2212  are shown on facing sides of the bone engaging members  2202 ,  2204  but may be on any or all sides of the bone engaging members. 
     The implant  2200  may have projections or other connecting means  2214 ,  2216  for connection with a means of insertion, such as inserter  2300 . The connecting means  2214 ,  2216  may be referred to as tabs, ears, protrusions, retainers, wings, or retaining members. The connecting means  2214 ,  2216  are shown extending outwardly from the front surface  2209  from the ends  2230 ,  2232  of the bridge  2206 , respectively, along a front to back direction established between the front surface  2209  and the back surface  2211 . This example also includes connecting means  2215 ,  2217  which are identical to connecting means  2214 ,  2216 , respectively, but which extend outwardly from the back surface  2211  from the ends  2230 ,  2232  of the bridge  2206 , respectively, along the front to back direction. Connecting means  2215  is not visible. The connecting means  2214 ,  2215 ,  2216 ,  2217  have surfaces  2218 ,  2219 ,  2220 ,  2221  respectively. Surface  2219  is not visible. The surfaces  2218 ,  2219 ,  2220 ,  2221  may releasably engage with a means of insertion that may allow the inserter  2300  or other means of insertion to be side loading, top loading, pivotably loaded, or end loading. For example, the inserter  2300  may be described as end loading. The surfaces  2218 ,  2219 ,  2220 ,  2221  may be referred to as bone facing surfaces since they angle outwardly and face distally. Referring to  FIGS. 5B and 9D , the surfaces  2218 ,  2219 ,  2220 ,  2221  are proximally spaced apart from, or proximally offset from, from the surface  2210 . The dashed extension lines  2210 ′,  2210 ″ in  FIGS. 9C-9D  show the level) of the surface  2210  versus the surfaces  2218 ,  2220 ,  2221 . In this example, connecting means  2214  and surface  2218  extend across the bridge  2206  toward the right end  2232  to merge with connecting means  2216  and surface  2220 . Likewise, connecting means  2217  and surface  2221  extend across the bridge  2206  toward the left end  2230  to merge with connecting means  2215  and surface  2219 . Taken together, the connecting means  2214 ,  2215 ,  2216 ,  2217  and surfaces  2218 ,  2219 ,  2220 ,  2221  form a dovetail rail  2213  that extends completely across the bridge  2206  from left to right. However, in other examples, the connecting means  2214 ,  2215 ,  2216 ,  2217  may be discrete features. 
     Referring to  FIGS. 9A-9B , the implant  2200  includes an optional reinforcing member  2250  which may be metal, for example a nickel titanium alloy. When the implant  2200  includes the reinforcing member, the implant may also include a base member  2252 , which in this example is the polymer portion of the implant  2200  other than the reinforcing member  2250 . The polymer may be PEEK. The base member  2252  may be easily molded with the desired three-dimensional characteristics for the implant  2200 . The base member  2252  may include an optional channel  2254  into which the optional reinforcing member  2250  is fitted. The implant  2200  may be referred to as a hybrid implant  2200  because it includes a polymer base member  2252  and a metal reinforcing member  2250 . Alternatively, the implant  2200  may lack the reinforcing member  2250  and the channel  2254 . 
     The means of insertion may maintain a one piece implant in a first configuration thereby allowing a second implant configuration once the implant is disassembled from the implant. The first configuration may be an elastically deformed state, for example an insertion state. The second configuration may be a free state or an implanted state. The means of insertion may utilize features similar to connecting means  2214  and  2216  in combination with other surfaces such as top surface  2208 . This combination of means of insertion may be used to maintain one or more features or arras or projections in a particular configuration. This combination of means of insertion may create a bending modality, such as a three point or four point bend, to maintain a specific implant configuration or combination of configurations. A combination of surfaces and means of insertion, such as connecting means  2214 , may be used on the entire implant or portions of an implant to create or maintain a particular configuration of an implant. For example, a protrusion such as  2214  and top surface, such as  2208  may be used to maintain one side of an implant or one arm of an implant in a particular configuration. When disassembled, that arm may have a configuration that is different from or the same as the configuration of the rest of the implant. 
     Referring to  FIGS. 9A-9D , the implant  2200  is shown uncoupled from the inserter  2300 . The implant  2200  is in a free state, or relaxed state, which is the shape of the implant  2200  when no external forces are acting upon the implant  2200 , other than gravity; the implant  2200  experiences no elastic or plastic deflection or deformation. In the free state, the bone engaging members  2202 ,  2204  converge as they extend away from the bridge  2206  so that the distal ends  2236 ,  2240  are closer together than the proximal ends  2234 ,  2238 . An angle  2222  is formed between the converging bone engaging members  2202 ,  2204  in the free state. The angle  2222  opens toward the bridge  2206 . The angle  2222  may be referred to as a free state angle. 
     The implant  2200  may be fabricated from any suitably elastic biocompatible material. The implant  2200  is preferably made of metal or polymer, preferably nitinol or polyetheretherketone (PEEK). 
     Referring to  FIGS. 5A-8 , the inserter  2300  includes a body  2400 , a left capture member  2500 , a right capture member  2600 , and a control member  2700 . The capture members  2500 ,  2600  are separate component parts in this example, however the capture members  2500 ,  2600  may optionally be integrally formed with the body  2400  as a single part. 
     The illustrated inserter  2300  has a first plane of symmetry along plane  11  of  FIG. 5A , which is shown edge on in  FIG. 5B  and is thus represented by a line  11 . The inserter  2300  may have a second plane of symmetry along plane  12 , which is shown edge on in  FIG. 9D  and is thus represented by a line  12 . The first and second planes of symmetry are perpendicular to each other. The first plane of symmetry divides the inserter  2300  into left and right halves. The second plane of symmetry divides the inserter  2300  into front and back halves. The first and second planes of symmetry also apply to the implant  200 , the optional reinforcing member  2250 , the base member  2252 , the body  2400 , and the control member  2700 . However, in other examples, the inserter  2300  and/or implant  200  may have only one plane of symmetry, or no plane of symmetry so that they are asymmetric. 
     Referring to  FIGS. 5A-6B , the body  2400  is an elongated part that extends between a distal end  2402  and an opposite proximal end  2404 . The distal end  2402  may be referred to as a working portion and the proximal end  2404  may be referred to as a handle. The body  2400  has a front surface  2406 , an opposite back surface  2408 , a left side  2410 , and an opposite right side  2412 . The body  2400  includes a left half  2418  and a right half  2420 . The left and right halves  2418 ,  2420  may be mirror images of each other, except for the clip features discussed below. The left half  2418  has a distal portion  2422  and a proximal portion  2424 . The right half  2420  has a distal portion  2426  and a proximal portion  2428 . 
     Referring to  FIGS. 6A-6B , the left and right halves  2418 ,  2420  may be joined together by an optional flex bridge  2432 , which may bias the proximal portions  2424 ,  2428  away from each other. The flexible bridge  2432  is shown with a bend which may enhance flexibility of the flex bridge. The flex bridge  2432  may be replaced by another type of biasing element, such as a spring. The flex bridge  2432  is shown integral with the body  2400 , but the flex bridge may be a separate component part, for example a metal ribbon coupled to the left and right halves  2418 ,  2420 . Alternatively, the bridge  2432  may have the same flexibility as any other part of the body. The flex bridge  2432  includes a control slot  2458  which may have one or more narrow portions  2460  at intermediate locations along the control slot. One intermediate narrow portion  2460  is shown in this example. 
     The distal portions  2422 ,  2426  may meet at a central junction  2430 . The junction  2430  may be referred to as an intermediate connection. In this example, the distal portions  2422 ,  2426  overlap at the central junction  2430 . The left distal portion  2422  includes a left control pocket  2462  in the shape of a proximally concave hook at the central junction  2430 . The control pocket  2462  may include one or more narrow portions  2463  at locations along the control pocket. One proximal narrow portion  2463  is shown in this example. The right distal portion  2426  includes a right control pocket  2464  in the shape of a proximally concave hook at the central junction  2430 . The control pocket  2464  may include one or more narrow portions  2465  at locations along the control pocket. One proximal narrow portion  2465  is shown in this example. The right control pocket  2464  overlaps in front of the left control pocket  2462 . This arrangement may be reversed, and may be further modified to include three or more interdigitated control pockets. 
     The body  2400  includes a left recess  2414  and a right recess  2416 . The left recess  2414  extends into the distal end  2402  in the left half  2418 . The left recess  2414  includes a proximal wide portion  2450  and a distal narrow portion  2452 . The right recess  2416  extends into the distal end  2402  in the right half  2420 . The right recess  2416  includes a proximal wide portion  2454  and a distal narrow portion  2456 . The left recess  2414  is identical to the right recess  2416  in this example. The recesses  2414 ,  2416  may be referred to as formations or pockets. The recesses  2414 ,  2416  are optional, and are present when the capture members  2500 ,  2600  are separate from the body  2400 . When the capture members  2500 ,  2600  are integrally formed with the body  2400 , the recesses  2414 ,  2416  are not present. 
     Referring to  FIG. 5A , the proximal portions  2424 ,  2428  may be enlarged and rounded, or otherwise adapted to form comfortable handles for a user to grasp. The left proximal portion  2424  may optionally include a first clip feature  2434  and the right proximal portion  2428  may optionally include a second clip feature  2436 . The first and second clip features  2434 ,  2436  cooperate to releasably hold the left proximal portion  2424  at a fixed distance from the right proximal portion  2428 . The first clip feature  2434  includes a groove  2438  that receives and releasably retains a tooth  2440  included in the second clip feature  2436 . Multiple grooves and teeth are included to provide a ratchet interconnection that provides multiple different fixed distances between the proximal portions  2424 ,  2428 . The first and second clip features  2434 ,  2436  may be integral with the body  2400  as shown, or optionally may be separate component parts coupled to the proximal portions  2424 ,  2428 . The clip features  2434 ,  2436  shown may be replaced with another releasable retention mechanism. 
     Referring to  FIG. 8 , the left capture member  2500  has a distal end  2502 , an opposite proximal end  2504 , a front surface  2506 , an opposite back surface  2508 , a left side  2510 , and an opposite right side  2512 . The distal end  2502  may be referred to as a jaw or a connection. The distal end  2502  includes front and back walls  2522 ,  2524  which define a dovetail groove  2526  between the walls. Taken together, the walls  2522 ,  2524  and dovetail groove  2526  may be referred to as a formation, a clip (distinct from the first and second clip features  2434 ,  2436 ), a connection, or a capture member. The proximal end  2504  includes a locking member  2528  which in this example, when viewed from the front or back, is a proximally pointing triangular feature. A securing member  2530  extends between the locking member  2528  and the distal end  2502 . The securing member  2530  is narrower left to right than the locking member  2528 , so that bilateral undercuts are formed at the transition between the locking member and the securing member. 
     The right capture member  2600  in this example is identical to the left capture member  2500 . However, to differentiate the two parts, the right capture member is given reference number series  2600 . 
     The right capture member  2600  has a distal end  2602 , an opposite proximal end  2604 , a front surface  2606 , an opposite back surface  2608 , a left side  2610 , and an opposite right side  2612 . The distal end  2602  may be referred to as a jaw or a connection. The distal end  2602  includes front and back walls  2622 ,  2624  which define a dovetail groove  2626  between the walls. Taken together, the walls  2622 ,  2624  and dovetail groove  2626  may be referred to as a formation, a clip (distinct from the first and second clip features  2434 ,  2436 ), a connection, or a capture member. At the left side  2610 , the walls  2622 ,  2624  include front and back tabs  2632 ,  2634 , respectively, which protrude toward each other, thus narrowing the dovetail groove  2626  at the left side. The tabs are also present on the left capture member  2500  but are not visible in  FIG. 8 ; the front tab  2532  is visible in  FIG. 5A . The proximal end  2604  includes a locking member  2628  which in this example, when viewed from the front or back, is a proximally pointing triangular feature. A securing member  2630  extends between the locking member  2628  and the distal end  2602 . The securing member  2630  is narrower left to right than the locking member  2628 , so that bilateral undercuts are formed at the transition between the locking member and the securing member. 
     Referring to  FIG. 7 , the control member  2700  has a distal end  2702 , a proximal end  2704 , a front surface  2606 , and a back surface  2708 . A front longitudinal element  2714  extends between the distal end  2702  and the proximal end  2704 . A back longitudinal element  2716  extends between the distal end  2702  and the proximal end  2704  and is held spaced apart from the front longitudinal element  2714  by a distal stem  2718  and a proximal stem  2720 . The stems  2718 ,  2720  extend in a front to back direction. 
     The body  2400 , capture members  2500 ,  2600 , and control member  2700  may be fabricated from any suitable material. The body  2400  is preferably made of metal or polymer, preferably stainless steel or polycarbonate. The capture members  2500 ,  2600  are preferably made of metal or polymer, preferably stainless steel or polycarbonate. The control member  2700  is preferably made of metal or polymer, preferably stainless steel or polycarbonate. In one example, the body  2400  and control member  2700  are made of a polymer and the capture members  2500 ,  2600  are made of hardened steel. In another example, the body  2400  and the arras  2500 ,  2600  are integrally formed as a single part made of metal, preferably an elastic metal such as spring steel. In yet another example, the body  2400  and the arras  2500 ,  2600  are integrally formed as a single part made of polymer. 
     Referring to  FIG. 5A , when the inserter  2300  is operatively assembled, the left capture member  2500  is coupled to the body  2400  so that the distal ends  2402 ,  2502  face the same direction, the front surfaces  2406 ,  2506  face the same direction, and the left sides  2410 ,  2510  face the same direction. The wide portion  2450  of the left recess  2414  receives the locking member  2528  and the narrow portion  2452  receives at least a portion of the securing member  2530 . The right capture member  2600  is coupled to the body  2400  so that the distal ends  2402 ,  2602  face the same direction, the front surface  2406  and the back surface  2608  face the same direction, and the right side  2412  and the left side  2610  face the same direction. The wide portion  2454  of the right recess  2416  receives the locking member  2628  and the narrow portion  2456  receives at least a portion of the securing member  2630  The recesses  2414 ,  2416  engage the bilateral undercuts so that tension may be applied to the capture members  2500 ,  2600  by the inserter  2300 . The recesses  2414 ,  2416  may receive the securing members  2530 ,  2630  and locking members  2528 ,  2628  with a close fit or an interference fit, and may even be formed around the securing members  2530 ,  2630  and locking members  2528 ,  2628  (or vice versa) in a molding operation. When the capture members  2500 ,  2600  are coupled to the body  2400 , the dovetail grooves  2526 ,  2626  are aligned with each other. The capture members  2500 ,  2600  may be coupled to the body  2400  by screws, pins, rivets, press fit, dovetail connection, adhesive, over molding, insert molding, or other means. Preferably, the capture members  2500 ,  2600  are rigidly coupled to the body  2400 , and are removable for cleaning or replacement. As mentioned previously, the capture members  2500 ,  2600  may optionally be integrally formed with the body  2400  as a single part. The control member  2700  is coupled to the body  2400  by inserting the proximal stem  2720  in the control slot  2458 , preferably proximally past the narrow portion(s)  2460 , so that the front longitudinal element  2714  is adjacent to the front surface  2406  and the back longitudinal element  2716  is adjacent to the back surface  2408 . Alternatively, the back longitudinal element  2716  may be adjacent to the front surface  2406  and the front longitudinal element  2714  may be adjacent to the back surface  2408 . The distal stem  2718  may then be inserted into the control pockets  2462 ,  2464  by moving the control member  2700  distally, preferably so that the distal stem  2718  moves past the narrow portions  2463 ,  2465 , preferably until the distal stem  2718  is fully distally seated in the control pockets  2462 ,  2464 . When the distal stem  2718  is in the control pockets  2462 ,  2464 , the proximal stem  2720  may be distally positioned in the control slot  2458  distal to at least a proximal one of the narrow portion(s)  2460 , or distally spaced outside the control slot  2458 . 
     When the inserter  2300  is fully assembled as shown in  FIG. 5A , with the distal stem  2718  in the control pockets  2462 ,  2464 , as the proximal portions  2424 ,  2428  are moved toward each other, the gap  2444  becomes smaller, the left and right halves  2418 ,  2420  pivot about the central junction  2430  so that the capture members  2500 ,  2600  rotate proximally relative to the central junction  2430 , the optional flex bridge  2432  may deform so that the proximal bend becomes more pronounced, and, if present, the first and second clip features  2434 ,  2436  move towards each other so that eventually the tooth  2440  is received in the groove  2438 . The flex bridge preferably deforms elastically. When the proximal portions  2424 ,  2428  are pressed inwardly toward each other against the resistance of the flex bridge  2432 , the inserter  2300  is in a compressed state, also referred to as an actuated state. When the tooth  2440  is received in the groove  2438 , the inserter  2300  is in a locked state. Since there are multiple grooves  2438  and teeth  2440  in this example, then when the first tooth/recess are engaged, the inserter  2300  is in a first locked state; when the second tooth/recess are engaged, the inserter  2300  is in a second locked state; and so on for third, fourth, or higher locked states. When the distal stem  2718  is in the control pockets  2462 ,  2464 , the control member  2700  is in a first control position. When the inserter  2300  is connected to the implant  2200  and the control member  2700  is in the first control position, the inserter  2300  is captive to the implant  2200 ; the inserter  2300  cannot be disconnected from the implant  2200 . When the inserter  2300  is not connected to the implant  2200  and the control member  2700  is in the first control position, the inserter cannot be connected to the implant  2200 . 
     If present, the first and second clip features  2434 ,  2436  may be disengaged or released by the user after the implant  2200  is implanted. With the control member  2700  in the first control position, as the proximal portions  2424 ,  2428  are moved away from each other, the left and right halves  2418 ,  2420  pivot about the central junction  2430  so that the capture members  2500 ,  2600  rotate distally relative to the central junction  2430 , the flex bridge  2432  relaxes so that the proximal bend becomes less pronounced, and, if present, the first and second clip features  2434 ,  2436  move away from each other. The proximal portions  2424 ,  2428  may be biased by the flex bridge  2432  to move away from each other automatically as soon as inward pressure on the proximal portions  2424 ,  2428  is released, or, if present, as soon as the first and second clip features  2434 ,  2436  are disengaged or released. When the first and second clip features  2434 ,  2436  are disengaged or released, the inserter  2300  is in an unlocked state. When the flex bridge  2432  has relaxed to its free state, the inserter  2300  is in a free state. In the free state, the proximal portions  2424 ,  2428  are separated by a gap  2444  having a free state dimension  2446 . 
     With the inserter  2300  in the free state, the control member  2700  may be moved proximally to move the proximal stem  2720  into the control slot  2458 , preferably past at least a distal one of the narrow portion(s)  2460 , preferably until the proximal stem  2720  is fully proximally seated in the control slot  2458 ; and to move the distal stem  2718  out of the control pockets  2462 ,  2464 , preferably proximally past the narrow portions  2463 ,  2465 . When the distal stem  2718  is out of the control pockets  2462 ,  2464 , the control member  2700  is in a second control position in which the inserter  2300  is connectable to, and disconnectable from, the implant  2200 . The inserter  2300  may now be actuated to connect or disconnect the inserter  2300  and the implant  2200 . 
     As the proximal portions  2424 ,  2428  are moved toward each other, the gap  2444  becomes smaller, the left and right halves  2418 ,  2420  pivot about the proximal stem  2720  so that the capture members  2500 ,  2600  rotate outwardly left and right, respectively, relative to the proximal stem  2720 , and, if present, the first and second clip features  2434 ,  2436  move towards each other so that eventually the tooth  2440  is received in the groove  2438 . 
     As the proximal portions  2424 ,  2428  are moved away from other, the gap  2444  becomes larger, the left and right halves  2418 ,  2420  pivot about the proximal stem  2720  so that the capture members  2500 ,  2600  rotate inwardly from left and right, respectively, relative to the proximal stem  2720 , and, if present, the first and second clip features  2434 ,  2436  move away from each other. 
     Referring to  FIGS. 5A-5B , the implant  2200  is shown coupled or connected to the inserter  2300 . The implant  2200  and inserter  2300  are each in the free state. With the control member  2700  in the second control position, the implant  2200  may be coupled to the inserter  2300  by actuating the inserter  2300 , engaging the dovetail grooves  2526 ,  2626  of the capture members  2500 ,  2600  to the connecting means  2214 ,  2215 ,  2216 ,  2217  of the implant  2200 , for example by sliding, and spreading apart the proximal portions  2424 ,  2428  of the inserter  2300 . The inserter  2300  is secured to, for example, clips over, around, and/or underneath the connecting means of the implant  2200 . With the bridge  2206  parallel to the second plane of symmetry as shown in  FIGS. 5A-5B , the dovetail grooves  2526 ,  2626  may slide straight into engagement with the connecting means  2214 ,  2215 ,  2216 ,  2217  along the longitudinal direction established by the bridge  2206 . In the example shown, the dovetail grooves  2526 ,  2626  slide onto the dovetail rail  2213 . When the implant  2200  is coupled to the inserter  2300 , the distal portions  2422 ,  2426  of the body  2400  extend along and above the bridge  2206  of the implant  2200  so that the central junction  2430  is adjacent to a middle portion of the bridge  2206 . When the implant  2200  and inserter  2300  are each in the free state, the central junction  2430  may contact the bridge  2206 , or the central junction  142  may optionally be separated from the bridge by a gap  2431 . The proximal portions  2424 ,  2428  extend away from the bridge  2206  generally opposite the bone engaging members  2202 ,  2204 . The implant  2200  may be pre-loaded on the inserter  2300  in a package, such as a sterile package, with the implant  2200  in the free state. 
     With the control member  2700  in the second control position, the implant  2200  may be decoupled or disconnected from the inserter  2300  by actuating the inserter  2300 , disengaging the dovetail grooves  2526 ,  2626  from the connecting means  2214 ,  2215 ,  2216 ,  2217  by sliding the dovetail grooves  2526 ,  2626  outwardly left and right. The connection between the inserter  2300  and the implant  2200  may be ruptured by changing the shape of the inserter  2300 . 
     Referring to  FIGS. 5A-5B , when the implant  2200  is coupled to the inserter  2300 , the walls  2522 ,  2524 ,  2622 ,  2624  may not extend below the lower surface  2210  of the bridge  2206 , due at least in part to the arrangement of the surfaces  2218 ,  2219 ,  2220 ,  2221  of the connecting means  2214 ,  2215 ,  2216 ,  2217  being proximally offset from the lower surface  2210  of the bridge  2206 . Instead, the walls  2522 ,  2524 ,  2622 ,  2624  may be even with, or flush with, the lower surface  2210 ; or proximally spaced apart from, or proximally offset from, the lower surface  2210 . More specifically, the distal-most aspect of each wall  2522 ,  2524 ,  2622 ,  2624  may be at the same level as, or proximal to, the lower surface  2210 . This is significant because the lower surface  2210  may contact a bone surface when the implant  2200  is implanted. In examples where the walls  2522 ,  2524 ,  2622 ,  2624  are flush with, or proximally offset from, the lower surface  2210 , the implant  2200  may be fully seated against the bone surface without interference from the walls  2522 ,  2524 ,  2622 ,  2624  against the bone surface. Referring to  FIG. 9C , the dashed extension lines  2210 ′,  2210 ″ show the level of the lower surface  2210  when the implant  2200  is in the free state.  FIG. 5B  illustrates that the bridge  2206 , connecting means  2214 ,  2215 ,  2216 ,  2217 , and the entire inserter  2300  are located on the proximal side of the lower surface  2210 . 
     Referring to  FIGS. 5A-5B , when the implant  2200  is coupled to the inserter  2300 , the inserter  2300  may be actuated to urge the implant  2200  into an elastically deformed state. The inserter  2300  may be moved from the free state to the compressed state, or to a first, second, or higher locked state if the first and second clip features  2434 ,  2436  are present. With the control member  2700  in the first control position, as the inserter  2300  moves from the free state to the compressed state or the locked state, the capture members  2500 ,  2600  rotate proximally relative to the central junction  2430  and the gap  2431  decreases until the central junction  2430  contacts the upper surface  2208  of the bridge  2206  and presses the bridge distally against the resistance of the dovetail grooves  2526 ,  2626  engaged with the connecting means  2214 ,  2215 ,  2216 ,  2217 . The control member  2700  may press distally against the central junction  2430  as the inserter  2300  is actuated. In the example, the central junction  2430  contacts and pushes against the middle of the upper surface  2208  to put the bridge into three point bending. However, the central junction  2430  may be designed to contact and push against a different location along the upper surface  2208 , or multiple locations. A central junction designed to contact two separate locations along the upper surface  2208  would put the bridge into four point bending, for example. While in the illustrated example, the proximal portions  2424 ,  2428  are moved toward each other to actuate the inserter  2300 , in other examples the proximal portions  2424 ,  2428  may be moved away from each other, or otherwise moved relative to each other, to actuate the inserter  2300 . 
     Actuating the inserter  2300  from the free state to the compressed state or the locked state puts the implant  2200  into an elastically deformed state in which the distal ends  2236 ,  2240  of the bone engaging members  2202 ,  2204  are farther away from each other than they are in the implant free state. The inserter  2300  may urge the implant  2200  into a first elastically deformed state in which the distal ends  2236 ,  2240  are farther apart than they are in the implant free state, but not as far apart as the proximal ends  2234 ,  2238 , so that the bone engaging members  2202 ,  2204  still converge slightly; a second elastically deformed state in which the distal ends  2236 ,  2240  and the proximal ends  2234 ,  2238  are the same distance apart, so that the bone engaging members  2202 ,  2204  are parallel, at least to the unaided eye; or a third elastically deformed state in which the distal ends  2236 ,  2240  are farther apart than are the proximal ends  2234 ,  2238 , so that the bone engaging members  2202 ,  2204  diverge. 
     As the inserter  2300  moves from the compressed state or the locked state to the free state, the capture members  2500 ,  2600  rotate distally relative to the central junction  2430  and the central junction  2430  moves away from the upper surface  2208  of the bridge  2206  to allow the bridge  2206  and the entire implant  2200  to relax toward the implant free state. 
     In this example, the implant  2200  may be decoupled or disconnected from the inserter  2300  when the implant  2200  is in the free state or an elastically deformed state. The inserter  2300  may be decoupled or disconnected from the implant  2200  when the inserter  2300  has been prepared for implant disconnection by moving the control member  2700  to the second control position. 
     A surgical method for stabilizing first and second bone fragments may include any or all of the following steps in any order: preparing a first hole in the first bone fragment; inserting a temporary fixation pin in the first hole; preparing a second hole in the second bone fragment; determining an implant size corresponding to the first and second holes; selecting the proper size implant  2200 ; coupling the selected implant  2200  to the inserter  2300 , the implant  2200  in the free state; urging the implant  2200  into an elastically deformed state; inserting the bone engaging member  2202  into the first hole and the bone engaging member  2204  into the second hole; seating the lower surface  2210  against a surface of the first or second bone fragment; allowing the implant  2200  to relax toward the implant free state; and decoupling the inserter  2300  from the implant  2200 . Allowing the implant  2200  to relax toward the implant free state may comprise releasing inward pressure on the proximal portions  2424 ,  2428 . Optionally, allowing the implant  2200  to relax toward the implant free state may comprise disengaging the first and second clip features  2434 ,  2436 . 
     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. 
     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. 
     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. 
     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. 
     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.