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

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 ۲۰۱۵ and ۲۰۲۳. 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 ۱۰۴۰ patients with a median age of ۷۲ (range ۶۰-۹۹) in this study. The mean CCD angle in the Iranian population was ۱۳۰.۶ ± ۵.۹ (range: ۱۱۵.۴-۱۴۹). ۱۱۷ (۱۱.۳%) 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 ۲۰.۳۵% 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

کلیدواژه ها:

Caput-Collum-Diaphyseal Angle ، Implant Design ، Iranian Population ، Neck Shaft Angle ، Proximal Femoral Nail