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

Articles in Press

Document Type : RESEARCH PAPER

Authors

1 a Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran b Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

2 Bone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran

5 Tehran University of Medical Sciences Joint Reconstruction Research Center

10.22038/abjs.2025.89209.4052

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 according to anthropometric studies in the Western population. In this study, we aimed to evaluate the Caput-collum-diaphyseal (CCD) angle in the Iranian population and find if any design modification for PFNs is needed for the Iranian population.
Methods: In this retrospective study, we evaluated patients with hip and pelvic radiographs who visited 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 of 1040 patients with a median age of 72 (range: 60- 99) was evaluated in this study. The mean CCD angle of the Iranian population was 130.6 ± 5.9 (range: 115.4- 149). It was found that 117 (11.3%) of the patients had Coxa Vara or Coxa Valga. The CCD angles were not significantly different 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.

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The Archives of Bone and Joint Surgery

Articles in Press, Accepted Manuscript
Available Online from 13 May 2026

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History

  • Receive Date: 19 July 2025
  • Revise Date: 16 November 2025
  • Accept Date: 20 September 2025

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