Contradictory guidance, divided practice: a national survey of the compression screw in dynamic hip screw fixation.

Abstract

Background: The compression screw is an optional ancillary component of the dynamic hip screw construct. Guidance on whether to use it, and whether to retain or remove it, is contradictory between the AO, the manufacturers and the biomechanical literature, and no clinical study has compared the two. The aim was to establish current UK practice, understanding and training.

Methods: A ten-question electronic survey was distributed through Training Programme Directors in all 23 United Kingdom deaneries and through trainee networks, open from 20 April to 19 July 2025. Users were defined from the direct question on frequency of use. Proportions are reported with Wilson 95% confidence intervals and compared using Fisher's exact test. Free text was coded thematically.

Results: One hundred responded: 42 junior and 41 senior trainees, 17 consultants. Seventy-four per cent (95% CI 65-82) use the compression screw at least occasionally. Of these, 38 (51%) remove it, 22 (30%) leave it in and 14 (19%) decide case by case, without difference by grade (p = 0.43). Ninety identified on-table compression correctly, yet 40% endorsed the belief that a retained screw prevents further compression on mobilisation. Thirty-seven per cent had no teaching; teaching predicted use (p = 0.0008), not understanding (p = 0.61).

Conclusion: There is no consensus on use of the compression screw and practice does not converge with seniority. Teaching appears to transmit practice rather than mechanism. Explicit teaching, and a comparative study of retention versus removal, are warranted.