Perilunate dislocations and perilunate fracture-dislocations are high-energy wrist injuries, characterized by a spectrum of bony and ligamentous damage. Clinical presentation often includes decreased range of motion, swelling and pain, and a palpable wrist deformity, while radiographic evaluation of the wrist may reveal abnormal radiocarpal and intercarpal collinearity and bony insult. This particular trauma may be difficult to detect due to nonspecific clinic presentation and subtle imaging findings, and can be missed in up to 25% of initial evaluations. Prompt recognition is essential for optimal patient outcomes, as the majority of patients are young adults and thus duration of disability is significant.