Emphasis in the literature over the past hundred years regarding distal radius fracture management has been on restoration of anatomic radio-carpal alignment. Until the two most recent decades, little emphasis has been placed on the great morbidity and compromise to upper limb function associated with distal radio-ulna joint (DRUJ) pathology occurring with fractures of the distal radius. This article emphasizes that attention to restoration of anatomy of the DRUJ should be considered at least as important as that given to the radio-carpal relationship. This article also points out how stiffness of forearm rotation can result from a well-treated distal radius fracture and how this complication can be treated to restore healthy upper limb function.