Trapezoidal osteotomy of distal radius. A, Preoperative posteroanterior view with decreased radial inclination; osteotomy and trapezoidal graft site are outlined. B, Postoperative posteroanterior view shows normal radial tilt and single “caging” pin. C, Abnormal dorsal tilt of radial articular surface reverses all loads across carpals and does not tolerate loading in active patients. D, Postoperative lateral view shows restoration of 11 degrees of palmar tilt before insertion of graft.