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A surgical instrument may be used to apply tension to a flexible suture to close and secure a broken or cut bone (e.g. a sternum following a sternotomy). The device preferably applies an adjustable tension to the flexible suture in order to secure the bone together. Multiple instruments may be used

A surgical instrument may be used to apply tension to a flexible suture to close and secure a broken or cut bone (e.g. a sternum following a sternotomy). The device preferably applies an adjustable tension to the flexible suture in order to secure the bone together. Multiple instruments may be used together to ensure the desired tension is applied to the entire bone structure being secured with the flexible sutures. Once the desired tension is achieved, the device preferably provides a mechanism to apply a uniform twist to the flexible suture to lock the flexible suture in place and maintain the tension previously achieved. The device may automatically cut the flexible suture, or the flexible suture may be cut by the surgeon once the twisting action has been performed.

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1. A surgical instrument comprising: a base comprising a bone contacting surface that in use contacts at least a portion of at least one bone,a first device movably coupled with respect to the base and including a handle rotatable about a first axis, the first device operable in response to at least

1. A surgical instrument comprising: a base comprising a bone contacting surface that in use contacts at least a portion of at least one bone,a first device movably coupled with respect to the base and including a handle rotatable about a first axis, the first device operable in response to at least a partial rotation of the handle to tension a flexible suture extending about at least the portion of the at least one bone and concurrently reduce a distance between the handle and the bone contacting surface; anda second device including at least one portion rotatable with respect to the base about a second axis, the second device operable in response to rotation of the at least one portion thereof about the second axis to apply a plurality of twists to the flexible suture while the tension in the flexible suture is maintained. 2. The surgical instrument of claim 1 wherein said flexible suture is a stainless steel wire suture. 3. The surgical instrument of claim 1 wherein said base comprises an open slot sized to receive a portion of the flexible suture and the surgical instrument further comprises at least one member movable to selectively constrain the flexible suture in the slot. 4. The surgical instrument of claim 1 wherein the second axis is not parallel to the first axis. 5. The surgical instrument of claim 1 wherein the surgical instrument further comprises a sized slot to accommodate a portion of a tool to allow cutting of the flexible suture by the tool. 6. The surgical instrument of claim 1 wherein the surgical instrument further comprises a third device comprising an edge that breaks the flexible suture when a sufficient number of the plurality of twists have been applied to the flexible suture. 7. The surgical instrument of claim 1 wherein the first device comprises a tensioning shaft and a one way clutch, the tensioning shaft rotatably mounted with respect to a portion of the surgical instrument and comprising a flexible suture retaining structure to retain the flexible suture, and the one way clutch operably coupled to the tensioning shaft to limit rotation of the tensioning shaft to a single rotational direction. 8. The surgical instrument of claim 1, further comprising: a spring arranged to maintain the tension in the flexible suture at least in part when the second device applies the plurality of twists to the flexible structure. 9. The surgical instrument of claim 1 wherein the second device applies the plurality of twists to the flexible suture to secure the flexible suture extending about the portion of the at least one bone. 10. The surgical instrument of claim 1 wherein the second device applies the plurality of twists to the flexible suture to secure portions of the flexible suture together. 11. The surgical instrument of claim 1 wherein the second device comprises a twisting head in which one or more portions of the flexible suture are retained, the twisting head rotatably mounted to the base to rotate with respect thereto and apply the plurality of twists to the flexible suture while the tension in the flexible suture is maintained. 12. The surgical instrument of claim 1 wherein the second device comprises a twisting head in which one or more portions of the flexible suture are retained, the twisting head rotatable with respect to the bone contacting surface about the second axis to apply the plurality of twists to the flexible suture while the tension in the flexible suture is maintained, and the first device comprises a tensioning shaft including a flexible suture retaining structure to retain the flexible suture, the tensioning shaft rotatable about the first axis to tension the flexible suture. 13. The surgical instrument of claim 12 wherein the tensioning shaft is coupled to the twisting head such that a rotation of the twisting head about the second axis rotates the tensioning shaft about the second axis when the second device applies the plurality of twists to the flexible suture while the tension in the flexible suture is maintained. 14. The surgical instrument of claim 1 wherein the first device comprises a tensioning shaft comprising a flexible suture retaining structure to retain the flexible suture, the tensioning shaft arranged to rotate about a tensioning shaft rotation axis to tension the flexible suture, the tensioning shaft movably coupled to the base to vary a distance between the tensioning shaft and the bone contacting surface of the base when tensioning the flexible suture. 15. The surgical instrument of claim 14 wherein the handle is physically coupled to the tensioning shaft and the surgical instrument comprises a one-way clutch physically coupled to the tensioning shaft to restrict rotation of the tensioning shaft about the tensioning shaft rotation axis to a single rotational direction. 16. The surgical instrument of claim 14 further comprising a spring positioned between the tensioning shaft and the base arranged to apply a varying spring force to the flexible suture as the tensioning shaft is rotated about the tensioning shaft rotation axis to vary the distance between the tensioning shaft and the bone contacting surface of the base. 17. The surgical instrument of claim 1 wherein the second device comprises a twisting head in which one or more portions of the flexible suture are retained, the twisting head rotatably mounted to the base for rotation with respect thereto about a twisting head rotation axis to apply the plurality of twists to the flexible suture while the tension in the flexible suture is maintained, the twisting head further movably coupled to the base to vary a distance between the twisting head and the bone contacting surface of the base when the twisting head is rotated about the twisting head rotational axis. 18. The surgical instrument of claim 17 wherein the twisting head moves along a direction parallel to the twisting head rotation axis when the twisting head is rotated about the twisting head rotation axis. 19. The surgical instrument of claim 17 wherein the second device further comprises at least a first twisting member and at least a second twisting member, each of at least the first and the second twisting members positioned between the twisting head and the base, the first twisting member rotationally coupled to the second twisting member to transfer torque between the first twisting member and the second twisting member when the twisting head is rotated about the twisting head rotation axis, and the first twisting member further physically coupled to the second twisting member to allow relative translational movement therebetween when the twisting head is rotated about the twisting head rotation axis. 20. The surgical instrument of claim 1, further comprising a slot that extends through the base and at least a portion of the at least one portion of the second device that is rotatable with respect to the base about the second axis. 21. A surgical instrument to secure a flexible suture to at least one body part, the surgical instrument comprising: a base;a twisting head rotatably mounted to the base to rotate with respect thereto about a first axis to secure portions of the flexible suture together;a tensioning shaft comprising a flexible suture retaining structure, the tensioning shaft rotatably mounted to the twisting head to rotate with respect thereto about a second axis to apply tension to the flexible suture; anda handle physically coupled to the tensioning shaft, the handle operable to rotate the tensioning shaft about the second axis,wherein the twisting head is movably coupled to the base for movement with respect thereto along a direction parallel to the first axis to reduce a distance between the twisting head and a surface of the base when the tensioning shaft is rotated about the second axis to apply tension to the flexible suture. 22. The surgical instrument of claim 21, further comprising: a one way clutch, the one way clutch physically coupled between the handle and the twisting head and arranged to limit rotation of the handle to a single rotational direction. 23. The surgical instrument of claim 22 wherein the one way clutch comprises a spring. 24. The surgical instrument of claim 21 wherein the twisting head is rotatable about the first axis to apply a plurality of twists to the flexible suture to secure the portions of the flexible suture together. 25. The surgical instrument of claim 21 wherein the twisting head is rotatable about the first axis to apply at least one twist to the flexible suture to secure the flexible suture encircled about a portion of the at least one body part. 26. The surgical system of claim 21 wherein the surface of the base is positioned on the base to contact with the at least one body part when the tensioning shaft is rotated about the second axis to apply tension to the flexible suture. 27. The surgical system of claim 26 wherein the surface of the base is positioned on the base to contact with the at least one body part when the twisting head is rotated about the first axis to secure portions of the flexible suture together. 28. The surgical system of claim 21, further comprising a spring physically coupled between the twisting head and the base, the spring arranged to apply a spring force to the flexible suture that varies as the distance between the twisting head and the surface of the base is varied. 29. The surgical instrument of claim 21 wherein the twisting head is movably coupled to the base for movement with respect thereto along a direction parallel to the first axis to vary a distance between the twisting head and the surface of the base when the twisting head is rotated about the first axis. 30. The surgical instrument of claim 29, further comprising a spring physically coupled between the twisting head and the base, the spring arranged to apply a spring force to the flexible suture that varies as the distance between the twisting head and the surface of the base is varied. 31. The surgical instrument of claim 21, further comprising a spring arranged to apply a spring force to the flexible suture, a dimension of the spring varying during at least one of a rotation of the twisting head about the first axis and a rotation of the tensioning shaft about the second axis. 32. The surgical instrument of claim 21 wherein the second axis is non-parallel to the first axis. 33. The surgical instrument of claim 21, further comprising a slot that extends through the base and at least a portion of the twisting head. 34. A surgical instrument, comprising: a first device comprising a handle selectively operable to apply tension to a flexible suture extending around about a portion of at least one bone;a second device selectively operable to apply a number of twists to the flexible suture; anda base comprising a bone contacting surface to contact the at least one bone when the second device applies the number of twists to the flexible suture, wherein the second device is moveably coupled to the base to rotate with respect thereto to apply the number of twists to the flexible suture and to reduce a distance between the second device and the bone contacting surface of the base when the second device applies the number of twists to the flexible suture. 35. The surgical instrument of claim 34 wherein at least the first device maintains the tension in the flexible suture when the second device applies the number of twists to the flexible suture. 36. The surgical instrument of claim 35 wherein the first device comprises a tensioning shaft comprising a flexible suture retaining structure to retain the flexible suture, the tensioning shaft rotatably mounted in the surgical instrument, and the first device further comprising a one way clutch operably coupled to the tensioning shaft to limit rotation of the tensioning shaft to a single rotational direction. 37. The surgical instrument of claim 36, further comprising a spring arranged to maintain the tension in the flexible suture at least in part when the second device applies the number of twists to the flexible structure. 38. The surgical instrument of claim 34 wherein the number of twists secure the flexible suture in an encircled configuration about the portion of the at least one bone. 39. The surgical instrument of claim 34 wherein the second device comprises a twisting head in which one or more portions of the flexible suture are retained, the twisting head rotatable with respect to the base about a first axis to apply the number of twists to the flexible suture, and the first device comprises a tensioning shaft including a flexible suture retaining structure to retain the flexible suture, the tensioning shaft arranged to rotate about a second axis to tension the flexible suture, the second axis non-parallel to the first axis. 40. The surgical instrument of claim 34 wherein the first device comprises a tensioning shaft comprising a flexible suture retaining structure to retain the flexible suture, the tensioning shaft arranged to rotate about a rotation axis to tension the flexible suture, the tensioning shaft movably coupled to the base to vary a distance between the tensioning shaft and the bone contacting surface of the base when tensioning the flexible suture. 41. The surgical instrument of claim 40 wherein the handle is physically coupled to the tensioning shaft and the surgical instrument comprises a one-way clutch physically coupled to the tensioning shaft to restrict rotation of the tensioning shaft about the rotation axis to a single rotational direction. 42. The surgical instrument of claim 41, further comprising a spring positioned between the tensioning shaft and the base, the spring arranged to apply a varying spring force to the flexible suture as the tensioning shaft is rotated about the rotation axis to vary the distance between the tensioning shaft and the bone contacting surface of the base. 43. The surgical instrument of claim 34 wherein the second device comprises a twisting head in which one or more portions of the flexible suture are retained, the twisting head rotatably mounted to the base for rotation with respect thereto about a rotation axis to apply the number of twists to the flexible suture, the twisting head further movably coupled to the base to move along a direction parallel to the rotation axis when the twisting head is rotated about the rotation axis. 44. The surgical instrument of claim 34, further comprising a slot that extends through the base and at least a portion of the second device. 45. The surgical instrument of claim 34 wherein the first device is selectively operable to apply the tension to the flexible suture while concurrently reducing a distance between at least a portion of the first device and the bone contacting surface.