Surgical approaches to the distal radioulnar joint

The distal radioulnar joint (DRUJ) is classified as a uniaxial synovial pivot joint between the convex head of the ulna and the concave ulnar notch of the radius. The DRUJ can be approached from 3 sides with a refined dorsal approach retaining a robust retinacular-dorsal capsular layer preferred by most surgeons. Recent descriptions of safe and extensile volar approaches have broadened indications for a volar approach to the DRUJ. A subcutaneous ulnar approach remains an option particularly when dealing with additional distal ulnar pathology. A description of technique and review of the surgical experience in exposure and treatment of DRUJ pathology will be presented, with advantages, disadvantages, and authors' preferred techniques.