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An open implant closure structure includes a helically wound guide and advancement structure having at least two helically wound forms thereon providing a multi-start closing mechanism for use between spaced arms of a cooperating open medical implant having mating helically wound structure thereon.

An open implant closure structure includes a helically wound guide and advancement structure having at least two helically wound forms thereon providing a multi-start closing mechanism for use between spaced arms of a cooperating open medical implant having mating helically wound structure thereon. Illustrated structures include interlocking flange forms, v-threads, square threads, reverse angle threads and buttress threads and receivers with break-off extensions and cooperating tooling.

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1. A medical implant assembly comprising: a receiver having a first arm and a second arm;a channel formed by the first arm and the second arm, the channel adapted to receive a longitudinal connecting member;a closure having an axis of rotation for closing the channel, the closure having a bottom sur

1. A medical implant assembly comprising: a receiver having a first arm and a second arm;a channel formed by the first arm and the second arm, the channel adapted to receive a longitudinal connecting member;a closure having an axis of rotation for closing the channel, the closure having a bottom surface that is closed and flat, the bottom surface engaging and locking the longitudinal connecting member within the channel;a first continuous helically wound form disposed on the closure, the first helically wound form having a first start;a second continuous helically wound form disposed on the closure, the second helically wound form having a second start;a first discontinuous helically wound structure on the first arm; anda second discontinuous helically wound structure on the second arm, a rotation of the closure about the axis of rotation between the first arm and the second arm causing a simultaneous mating of the first start with the first discontinuous helically wound structure and the second start with the second discontinuous helically wound structure. 2. The medical implant assembly of claim 1, wherein the first helically wound form and the second helically wound form are each flange forms. 3. The medical implant assembly of claim 1, wherein the first helically wound form and the second helically wound form are each v-threads. 4. The medical implant assembly of claim 1, wherein the first helically wound form and the second helically wound form are each square threads. 5. The medical implant assembly of claim 1, wherein the first helically wound form and the second helically wound form are each reverse angle threads. 6. The medical implant assembly of claim 1, wherein the first helically wound form and the second helically wound form are each buttress threads. 7. The medical implant assembly of claim 1, wherein the closure includes a breakoff head. 8. The medical implant assembly of claim 1, wherein the receiver includes one or more breakoff extensions. 9. The medical implant assembly of claim 1, further comprising: a guide tool having a first guide arm and a second guide arm detachably attached to the receiver;a third discontinuous helically wound structure on the first guide arm; anda fourth discontinuous helically wound structure on the second guide arm, the first start being mated with the third discontinuous helically wound structure simultaneously with the second start being mated with the fourth discontinuous helically wound structure when the closure is rotated between the first guide arm and the second guide arm, the third discontinuous helically wound structure and the fourth discontinuous helically wound structure adapted to transfer the closure between the guide tool and the receiver. 10. The medical implant assembly of claim 1, wherein the longitudinal connecting member is a rod. 11. The medical implant assembly of claim 1, wherein each of the first start and the second start is disposed at a top of the closure, the first helically wound form and the second helically wound form each extending along an outer surface of the closure to a bottom of the closure. 12. The medical implant assembly of claim 1, wherein the first start is disposed at a diametrically opposed location on the closure from the second start. 13. A medical implant assembly comprising: a receiver having a first arm spaced from a second arm, each of the first arm and the second arm having an inwardly facing surface;a channel formed by the first arm and the second arm, the channel adapted to receive a longitudinal connecting member;a closure having a body rotationally receivable within the receiver for closing the channel, the body having a bottom surface that is closed and flat, the bottom surface engaging and locking the longitudinal connecting member within the channel;at least one discontinuous helically wound guide and advancement structure disposed on the inwardly facing surfaces; andat least one helically wound guide and advancement structure disposed on and extending continuously along the body of the closure, the at least one helically wound guide and advancement structure having a plurality of starts adapted to matingly engage the at least one discontinuous helically wound guide and advancement structure. 14. The medical implant assembly of claim 13, wherein the at least one helically wound guide and advancement structure and the discontinuous helically wound guide and advancement structure are interlocking flange forms. 15. The medical implant assembly of claim 13, wherein the at least one helically wound guide and advancement structure includes a plurality of v-threads. 16. The medical implant assembly of claim 13, wherein the at least one helically wound guide and advancement structure includes a plurality of square threads. 17. The medical implant assembly of claim 13, wherein the at least one helically wound guide and advancement structure includes a plurality of reverse angle threads. 18. The medical implant assembly of claim 13, wherein the at least one helically wound guide and advancement structure includes a plurality of buttress threads. 19. The medical implant assembly of claim 13, wherein the plurality of starts is a double start. 20. The medical implant assembly of claim 13, wherein the plurality of starts simultaneously mate with the at least one discontinuous helically wound guide and advancement structure when the closure is rotated between the first arm and the second arm. 21. A medical implant assembly comprising: a receiver having a first arm and a second arm, the first arm having a first inwardly facing surface and the second arm having a second inwardly facing surface;a shank pivotable with respect to the receiver prior to locking of a position of the shank;a first discontinuous helically wound guide and advancement structure disposed on the first inwardly facing surface; anda second discontinuous helically wound guide and advancement structure disposed on the second inwardly facing surface, each of the first discontinuous helically wound guide and advancement structure and the second discontinuous helically wound guide and advancement structure adapted to mate with at least one closure helically wound guide and advancement structure having a plurality of starts. 22. The medical implant assembly of claim 21, wherein the plurality of starts is a double start. 23. The medical implant assembly of claim 21, further comprising: a guide tool having a first guide arm and a second guide arm detachably attached to the receiver;a third discontinuous helically wound guide and advancement structure on the first guide arm; anda fourth discontinuous helically wound guide and advancement structure on the second guide arm, the third discontinuous helically wound guide and advancement structure and the fourth discontinuous helically wound guide and advancement structure adapted to transfer a closure between the guide tool and the receiver.