The Distribution of Caput-Collum-Diaphyseal (Ccd) Angles in the Iranian Elderly Population: Implications for Proximal Femoral Nail Design Publisher



Razzaghof M ; Kalantar S H ; Hosseini Monfared P ; Mirahmadi A ; Talebi A ; Tabrizi B N ; Khosravi E ; Poursalehian M ; Mortazavi S M J
Source: Archives of Bone and Joint Surgery Published:2026

Abstract

Objectives: Proximal femoral nails (PFNs) are widely used in managing unstable proximal femur fractures. These implants are designed with fixed femoral neck-shaft angles in different sizes, based on anthropometric studies of the Western population. In this study, we aimed to evaluate the Caput-collum-diaphyseal (CCD) angle in the Iranian population and determine whether any design modification for PFNs is needed for this population. Methods: In this retrospective study, we evaluated patients who underwent hip and pelvic radiography at our hospital between 2015 and 2023. The CCD angles were measured on AP pelvic and hip radiographs. The mean CCD angle of the Iranian population was calculated. Correlation analysis was also conducted to evaluate the CCD angle in different age and sex groups. Results: The CCD angle was evaluated in 1040 patients with a median age of 72 (range 60-99) in this study. The mean CCD angle in the Iranian population was 130.6 ± 5.9 (range: 115.4-149). 117 (11.3%) of the patients had Coxa Vara or Coxa Valga. The CCD angles did not differ significantly between men and women. We observed a significant correlation between the patient’s age and the CCD angle. It was found that 20.35% of our population’s CCD is not covered by the most commonly available Western PFN designs. Conclusion: This study's findings demonstrated that the Iranian population's mean CCD angle is higher than in Western countries. Therefore, future PFN designs should consider the CCD angles of the specific populations. © 2025 Mashhad University of Medical Sciences.