Normal Radius Palmar Tilt Size on Radiography
The radius palmar tilt — also called volar tilt — describes the angle between the distal radial articular surface and a perpendicular to the radial shaft, measured on a true lateral wrist radiograph. It quantifies the natural palmar inclination of the distal radius. Accurate measurement is essential for evaluating distal radius fractures, guiding reduction maneuvers, and determining the need for surgical fixation.
Normal Reference Values
| Orientation | Measurement |
|---|---|
| Lateral | 2-20¡ |
Clinical Significance
The normal palmar tilt ranges from 2° to 20° on lateral projection. Loss of this angle — particularly reversal into dorsal tilt — is a hallmark of displaced distal radius fractures such as the classic Colles fracture, where the distal fragment tilts dorsally. Restoration of palmar tilt is a primary goal of closed reduction and surgical fixation, as residual dorsal angulation correlates with reduced grip strength, limited range of motion, and long-term wrist dysfunction.
Post-reduction radiographs should confirm adequate restoration of palmar tilt. A final dorsal tilt exceeding 0–5° is generally considered an indication for operative management, though acceptable thresholds vary by patient age, activity level, and associated injuries. Failure to appreciate asymmetric measurement due to patient positioning or oblique projections is a common pitfall.
- Colles fracture (dorsal tilt, common in osteoporotic bone)
- Smith fracture (exaggerated palmar tilt / volar displacement)
- Intra-articular distal radius fractures (Barton, die-punch)
- Malunion following inadequate reduction
- Physiological variation at the extremes of the normal range
Reference: Marincek B, Dondelinger RF. Emergency Radiology, Imaging and Intervention. Springer. (2007).
Imaging Notes
Palmar tilt is measured exclusively on a true lateral radiograph of the wrist, with the forearm in neutral rotation and the wrist in a neutral position. The angle is drawn between a line along the distal radial articular surface and a line perpendicular to the long axis of the radial shaft. Patient positioning is critical — even minor forearm rotation introduces significant measurement error, falsely increasing or decreasing the apparent tilt.
When assessing post-reduction films, ensure the lateral view is obtained with strict technique to allow reliable comparison with pre-reduction measurements. CT may supplement radiography for complex intra-articular fractures but palmar tilt assessment on CT requires careful plane selection to replicate the true lateral orientation.