Volar tilt

Changed by Leonardo Lustosa, 14 Sep 2022

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Volar tilt, or palmar tilt, is aan important measurement ofin the ~~angulation~~evaluation of ~~the~~ distal radius fractures and radial deformities.

Measurement

The volar tilt ~~measurement~~ is ~~made~~assessed on the lateral ~~wrist projection~~ ~~as an angle~~radiograph of the ~~distal radial surface with respect~~wrist, it corresponds to the angle formed by a line ~~perpendicular to~~drawn along the axis of the radial shaft, and a line that passes through the tips of the dorsal and volar rims (i.e. along the radius articular surface) ^1,^2,5-⁸.

Interpretation

~~≤0°~~normal: ~~dorsal tilt; >10° is a relative indication for~~ ~~distal radius fracture~~ ~~reduction~~7-15º ^35-7, an average of 11º ^1-8 - some authors consider the normal range 2-20º ^4,8
~~10-25°: normal range~~>10º of dorsal tilt is related to worse outcomes ^19,10
>20º of volar tilt is related to unstable fractures and worse outcomes ⁵
>25°:º of volar tilt can contribute to dorsal intercalated segment instability (DISI) ²⁹

The term dorsal tilt is sometimes used if the angulation is dorsal rather than volar, negative values of volar tilt can be used instead to indicate a dorsal angulation.

-<p><strong>Volar tilt</strong> is a measurement of the angulation of the distal <a title="Radius" href="/articles/radius">radius</a>. </p><h4>Measurement</h4><p>The volar tilt measurement is made on the <a title="Wrist (lateral view)" href="/articles/wrist-lateral-view-2">lateral wrist projection</a> as an angle of the distal radial surface with respect to a line perpendicular to the shaft.</p><h4>Interpretation</h4><ul>
~~-<li>≤0°: dorsal tilt; >10° is a relative indication for <a title="Distal radius fracture" href="/articles/distal-radial-fracture">distal radius fracture</a> reduction <sup>3</sup>~~
+<p><strong>Volar tilt</strong>, or palmar tilt, is an important measurement in the evaluation of distal radius fractures and radial deformities.</p><h4>Measurement</h4><p>The volar tilt is assessed on the lateral radiograph of the wrist, it corresponds to the angle formed by a line drawn along the axis of the radial shaft, and a line that passes through the tips of the dorsal and volar rims (i.e. along the radius articular surface) <sup>1,</sup><sup>2,5-</sup><sup>8</sup>.</p><h4>Interpretation</h4><ul>
+<li>normal: 7-15º <sup>5-7</sup>, an average of 11º <sup>1-8</sup> - some authors consider the normal range 2-20º <sup>4,8</sup>
~~-<li>10-25°: normal range <sup>1</sup>~~
+<li>>10º of dorsal tilt is related to worse outcomes <sup>9,10</sup>
~~-<li>>25°: can contribute to <a title="DISI" href="/articles/dorsal-intercalated-segment-instability">dorsal intercalated segment instability (DISI)</a> <sup>2</sup> </li>~~
+<li>>20º of volar tilt is related to unstable fractures and worse outcomes <sup>5</sup>
+</li>
+<li>>25º of volar tilt can contribute to <a href="/articles/dorsal-intercalated-segment-instability">dorsal intercalated segment instability (DISI)</a> <sup>9</sup> </li>
+</ul><p>The term dorsal tilt is sometimes used if the angulation is dorsal rather than volar, negative values of volar tilt can be used instead to indicate a dorsal angulation.</p><h4>See also</h4><ul>
+<li><a title="Distal radial fracture" href="/articles/distal-radial-fracture">distal radius fractures</a></li>
+<li><a href="/articles/dorsal-intercalated-segment-instability">dorsal intercalated segment instability (DISI)</a></li>

References changed:

1. Scott W. Wolfe, Robert N. Hotchkiss, William C. Pederson et al. Green's Operative Hand Surgery. (2016) ISBN: 9781455774272 - <a href="http://books.google.com/books?vid=ISBN9781455774272">Google Books</a>
2. Charles M. Court-Brown, James D. Heckman, Margaret M. McQueen et al. Rockwood and Green's Fractures in Adults. (2015) ISBN: 9781451175318 - <a href="http://books.google.com/books?vid=ISBN9781451175318">Google Books</a>
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5. Perugia D, Guzzini M, Civitenga C et al. Is It Really Necessary to Restore Radial Anatomic Parameters After Distal Radius Fractures? Injury. 2014;45:S21-6. <a href="https://doi.org/10.1016/j.injury.2014.10.018">doi:10.1016/j.injury.2014.10.018</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25457314">Pubmed</a>
6. Mignemi M, Byram I, Wolfe C et al. Radiographic Outcomes of Volar Locked Plating for Distal Radius Fractures. J Hand Surg Am. 2013;38(1):40-8. <a href="https://doi.org/10.1016/j.jhsa.2012.10.007">doi:10.1016/j.jhsa.2012.10.007</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23218558">Pubmed</a>
7. Medoff R. Essential Radiographic Evaluation for Distal Radius Fractures. Hand Clin. 2005;21(3):279-88. <a href="https://doi.org/10.1016/j.hcl.2005.02.008">doi:10.1016/j.hcl.2005.02.008</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/16039439">Pubmed</a>
8. Ralph Weissleder. Primer of Diagnostic Imaging. (2011) ISBN: 9780323065382 - <a href="http://books.google.com/books?vid=ISBN9780323065382">Google Books</a>
9. David J. Slutsky, A. Lee Osterman. Fractures and Injuries of the Distal Radius and Carpus. (2009) ISBN: 9781416040835 - <a href="http://books.google.com/books?vid=ISBN9781416040835">Google Books</a>
10. Cherubino P, Bini A, Marcolli D. Management of Distal Radius Fractures: Treatment Protocol and Functional Results. Injury. 2010;41(11):1120-6. <a href="https://doi.org/10.1016/j.injury.2010.09.016">doi:10.1016/j.injury.2010.09.016</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/20934699">Pubmed</a>
1. Borut Marincek, Robert F. Dondelinger. Emergency Radiology. (2007) ISBN: 9783540689089 - <a href="http://books.google.com/books?vid=ISBN9783540689089">Google Books</a>
2. Ralph Weissleder. Primer of Diagnostic Imaging. (2011) ISBN: 9780323065382 - <a href="http://books.google.com/books?vid=ISBN9780323065382">Google Books</a>
3. David J. Slutsky, A. Lee Osterman. Fractures and Injuries of the Distal Radius and Carpus. (2009) ISBN: 9781416040835 - <a href="http://books.google.com/books?vid=ISBN9781416040835">Google Books</a>