We present the case of a patient with bilateral Galeazzi fracture-dislocations with an irreducible distal radioulnar joint (DRUJ) on one side. Current treatments, such as anatomic reduction and stable internal fixation of the radius and anatomic and stable reduction of the DRUJ followed by plaster immobilization in supination, have produced results much better than those associated with historical conservative treatments. The most important part of successful treatment is maintaining intraoperative control of reduction quality, DRUJ stability, and, if necessary, open reduction of the DRUJ. Here we describe the surgical technique and present the rare case of a DRUJ being irreducible because of interposition of the extensor carpi ulnaris tendon