The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

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

Document Type : RESEARCH PAPER

Authors
Mohammadreza Razzaghof 1
Seyed Hadi Kalantar 1
Pooya Hosseini-Monfared 2
Alireza Mirahmadi 3
Alireza Talebi 1
Behzad Nezhad Tabrizi 1
Erfan Khosravi 1
Mohammad Poursalehian 1
SM Javad Mortazavi 1
1 Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran -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
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, 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.
        Level of evidence: III
Keywords
Caput-collum-diaphyseal angle
Implant design
Iranian population
Neck shaft angle
Proximal femoral nail
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 7
July 2026
Pages 457-463

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