Normal Volar Tilt of the Wrist at Rest
The normal volar tilt of the distal radius at rest is approximately 11-12 degrees, which serves as the anatomic reference point for evaluating distal radius fracture reduction and alignment.
Anatomic Parameters
The normal volar tilt represents the palmar inclination of the distal radial articular surface when measured on a true lateral radiograph:
- Normal volar tilt ranges from 10-12 degrees in the uninjured wrist 1, 2, 3, 4
- This measurement is taken as the angle between a line perpendicular to the radial shaft and a line along the distal radial articular surface 2
- The contralateral (uninjured) wrist serves as the best individual reference, with studies reporting mean values of 11.7±2.3° 4
Clinical Significance in Fracture Management
Post-Reduction Targets for Adults
The American Academy of Orthopaedic Surgeons establishes clear thresholds for acceptable alignment after distal radius fracture reduction:
- Dorsal tilt >10 degrees post-reduction is an indication for operative fixation in non-geriatric patients (under age 65) 5
- This threshold represents moderate evidence that surgical intervention improves radiographic and patient-reported outcomes 5
- For geriatric patients (≥65 years), strong evidence shows operative treatment does not improve long-term patient-reported outcomes despite better radiographic parameters 5
Achieved Volar Tilt After Surgical Fixation
Studies of operatively treated distal radius fractures demonstrate:
- Final volar tilt averages 6-11 degrees after volar plate fixation 1, 3, 6
- Volar locking plate systems achieve mean volar tilt of 10 degrees, significantly better than fragment-specific fixation which averaged -10 degrees (dorsal tilt) 6
- Restoration to anatomic volar tilt (11.5±4.3°) is achievable with proper surgical technique 4
Functional Correlation
The relationship between volar tilt and clinical outcomes varies by patient age:
- In elderly patients, volar tilt correlates significantly with clinical outcomes (Mayo wrist score and DASH score) 2
- Patients with conservatively managed fractures achieving mean volar tilt of -1.2° had significantly better outcomes than those requiring corrective osteotomy for malunion 2
- However, radiographic parameters including volar tilt show weaker correlation with functional outcomes in geriatric patients compared to younger patients 5, 2
Key Clinical Pitfalls
Do not apply adult radiographic thresholds to pediatric patients, as children have superior remodeling capacity and different acceptable alignment parameters 7, 8. The 10-degree dorsal tilt threshold is specifically for adult fractures.
Ensure proper lateral radiograph technique when measuring volar tilt, as improper positioning can lead to inaccurate measurements and inappropriate treatment decisions 7.
Consider functional demand over chronologic age when applying the 65-year threshold, as this age serves as a proxy for functional demand rather than an absolute cutoff 5.