I broke the two bones in my left forearm years ago but didn’t require any hardware. So what would make it so I would need screws?
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If you break a bone in two but the two bits are actually lined up with each other in the line they should be, it means the are is the correct shape and there’s only a small gap where the two bones need to rejoin. Immobilise that area (eg with a cast) and they will heal together.
If you break a bone and the two parts end up are an angle they shouldn’t be at, you need to realign them into the correct shape, so that they will heal in the right shape. There are occasions circumstances where this can be done by pulling limb into the right position and then immobilising like that, but sometimes it maybe that you can’t do this and get it imo I listed with a cast or something externally, so you have to go in and put pins/screws in so the bones stay in the correct place while they heal.
If it’s not a clean break and bits have shattered or broken strangely, hardware maybe needed to bridge gaps
And with some big bones in limbs, even if it was a clean break, the muscles are big enough that they will pull the ends of the bone past each other, shortening the bone and you need to put hardware to ensure the limb will heal at the right length.
If you break your femur (thigh bone) one of the signs (other than massive pain!) is that the leg is shorter immediately. The quadriceps never fully relaxed (most muscles aren’t actually fully relaxed most of the time. That is normal), so when the long single bone the ends are attached to becomes two bones, the quadricep tension will pull those two bone past each other, making that section of the leg shorter. If it’s the hip part of the femur, the way the different muscles attach to the femur means that the leg is shortened and the leg externally rotated (foot pointing out) because of the various sizes tensions of those muscles. So the only way to get it to heal in the correct position is either metalwork to hold it in the right position, or traction (put basically a clamp round the bottom the the leg and the top to hold them in position, use weights to pull the leg back into position and then the patient is stuck in that position until it heals. Weeks and weeks, if not months of being stuck in bed, unable to get up, go to the toilet, have a shower, etc. sometimes you need a bit of both; hardware plus a short period of traction.
There are alternatives to hardware when there might be reasons you can’t put it in/do surgery on someone, but the best outcomes (normally functioning and shaped limb or where ever) is with hardware.
Sometimes a patient has other chronic health conditions that mean a general anaesthetic would kill the patient, or when there is severe osteoporosis when a bone would just crumble if you tried to put screws in it, and that’s when traction is the only real option. There can even be scenarios where you have to accept that there will be deformity if you can’t operate but try to control the deformity to a useable position by casting or similar non-surgical methods
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