Nineteen Galeazzi fracture-dislocations were reviewed clinically and roentgenographically at an average of 83 months after open reduction and internal fixation. Radiographic observation of fracture reduction was correlated with clinical results. Patients with anatomic fracture reduction had minimal sequelae and better or equal functional results than patients with imperfect reduction. Manual laborers had no weakness, but nonmanual laborers showed significant deficits in supination strength. Concomitant fractures of the wrist, the hand, or both were associated with significant pronation weakness. The volar approach was associated with a significant deficit of flexion/extension range of motion (ROM). Attention was focused on distal radioulnar joint (DRUJ) function and pain. Distal radioulnar joint function was fully restored by open reduction and internal fixation of the radius and indirect anatomic reduction and functional aftercare of the DRUJ in 16 cases. Open revision, repair of the triangular fibrocartilage complex (TFCC), and immobilization of the wrist are not necessary if anatomic reduction of the joint is obtained by indirect means such as open reduction and internal fixation of the radius.