Correlation between dorsal tilt and midcarpal alignment in distal radial fractures or malunions: a radiographic study

We studied the relationship between the dorsal tilt of the distal radius and midcarpal alignment, specifically the capitolunate angle, in patients with distal radials fractures or malunion.

We retrospectively reviewed 47 patients diagnosed with distal radial fractures or malunions between January 2000 and October 2025. Radiographic variables, including dorsal tilt, radiolunate angle and capitolunate angle, were measured on standard lateral radiographs. The effective radiolunate flexion (ERLF) angle was calculated to classify cases into those with adaptive midcarpal malalignment (Type 1: ERLF ⩽ 25°) and those with pathological radiocarpal malalignment (Type 2: ERLF > 25°). In Type 1 cases, correlation and regression analyses between dorsal tilt and capitolunate angles were carried out.

Of the 47 included cases, 39 were classified as Type 1 and eight as Type 2. A weak positive correlation was found between dorsal tilt and capitolunate angle in Type 1 cases (r = 0.43). The regression equation was y = 0.50x + 0.69 (R² = 0.21), indicating that increased dorsal tilt was associated with increased midcarpal flexion.

Midcarpal alignment in distal radial fractures and malunions demonstrates a measurable relationship with dorsal tilt of the radius. Our study supports the concept that an extra-articular dorsal tilt deformity of the distal radius can induce a corresponding adaptive malalignment at the midcarpal level.

IV.