This article presents the use of a constrained total distal radioulnar joint replacement with its indications, contraindications, pearls, and pitfalls. The distal radioulnar joint is a complex articulation that carries weight while allowing vector changes without interfering with its function. The total distal radioulnar joint is a solution to those cases with absence of the sigmoid notch, poor soft tissue, or too much ulnar bone resected. The ability of patients to return to regular activities is documented, with a 5-year follow-up.
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