Introduction 1 2 3 4 3 5 6 7 11 12 13 Materials and methods Inclusion criteria Patients aged 18 years or above with a unilateral dislocated distal radial fracture with the history of neither a distal radial fracture nor a distal radial operation were included after informed consent was taken. A stratification for the AO fracture types was performed to reflect the prevalence in clinical practice at a ratio of 5:2:3 for the AO type A, B and C distal radial fractures. The standard post-reduction (postero-anterior (PA) and lateral) X-rays and standard distal radius X-rays of the unaffected side of 30 consecutive patients visiting the emergency department were included after stratification for AO fracture type. 1 Fig. 1 Anatomical radiological classification for distal radial fractures according to Lidström  2 Fig. 2 Normal value measurement of the distal radius  3 3 Fig. 3 Measurements of distal radial fractures using the unaffected side as template  Statistical analysis 14 15 16 Results Thirty patients with distal radial fractures were included. Of these patients, 15 fractures were of AO classification group A, 6 AO classification group B and 9 of AO classification group C. 1 Table 1 N a Old technique (95% CI)  Template technique (95% CI) Radial length  0.53 (0.48/0.57) 0.54 (0.49/0.59) Radial inclination  0.36 (0.30/0.41) 0.49 (0.43/0.55) Volar angulation  0.60 (0.56/0.64) 0.64 (0.60/0.68) Lidström 0.37 (0.31/0.43) 0.59 (0.52/0.63) a Discussion Compared to the traditional quantitative technique, the template assessment technique resulted only in an improved inter-observer reproducibility for the radial inclination. There were slight improvements in reproducibility of the radial length and volar angulation. However, there was a notable improvement in the reproducibility of reduction results as assessed using the Lidström score. 6 In this comparative study we had the same observers and the same patients with a 2-month interval and X-rays presented in another sequence order to overcome possible bias. The patients’ sample was chosen to reflect the daily practice in which the AO type A fractures are more frequent than the Type B and C. 12 1 3 A limitation of the template technique is that it may not be applicable in patients with a bilateral fracture or patients with a history of a distal radial fracture or deformity on the other side. In this study, only patients with a unilateral distal radial fracture were included, reflecting the most common occurrence of distal radial fractures. Another limitation of this study was that, in order to avoid learning curves, only experienced observers were used, which may not always be the case in daily practice. Also, the templates of the unaffected side were made by the same investigator. In daily practice, making the template could also be a source of variation since the correct position of the templates may be more difficult in case of severe dislocation or with slight differences in projection of the bones due to the angle of the X-ray beam. Perhaps the use of digital subtraction may be helpful to overcome this. 4 5