Instability of the distal radioulnar joint is caused either by bone deformity, fracture or by ligament deficiency. The logical treatment will consist either in osteotomy, osteosynthesis, or in reconstruction of the ligamentous support. The refixation of the TFCC or the ulnar styloid has been demonstrated to be effective in correcting instability biomechanically and clinically. Near-anatomical TFCC reconstruction should always be striven for, rather than resorting to non-anatomical reconstructive procedures. Nevertheless, great efforts will be necessary in the future in order to better understand biomechanics, epidemiology, diagnosis, and treatment of distal radioulnar joint instability.