The distal radioulnar joint (DRUJ) is the distal link between the radius and the ulna, and forms a pivot for forearm pronation and supination. As well as being susceptible to idiopathic arthritis, any injury or deformity of the DRUJ involving the radius or ulna can alter the function of this joint. Treatment options for irreparable destruction of this joint have ranged from fusion of the DRUJ joint to a variety of excision techniques with soft-tissue reconstructions, and are ever evolving. Understanding the distal ulnar anatomy is key to success.