Metal bone screws are a fundamental element of fracture fixation. Screws are described by their thread diameter, thickness of the root of the screw, and pitch. Bone screws are inserted by first making a pilot hole. When screws are used to coapt or lag bone, then a channel has to be drilled the same diameter as the threads. Cannulation of a screw allows the screw to be placed over a guidewire. This increases accuracy of screw placement. More optimally designed screws may be available in the future with the use of finite element modeling for improved screw design.