Based on their personal experience with 49 carpal dislocations in 46 patients, the authors suggest the following in the management of the acute injury: (1) Dorsal trans-scaphoid perilunate dislocation. After closed reduction, if the scaphoid is not anatomically reduced, primary open reduction and internal fixation with Kirschner wires is advised. A volar (Russe-type) approach gives adequate exposure, and bone grafting probably is not necessary. Satisfactory results can be achieved if the operation is done anytime within 2 weeks of injury. (2) Dorsal perilunate and volar lunate dislocation. Since cineradiographic studies show clearly that the lunate dislocation is usually the end stage of a perilunate dislocation, these injuries are treated identically after the initial closed reduction. Indications for open reduction are rotary subluxation of the scaphoid or lunate instability (dorsiflexion instability or volar subluxation). A dorsal approach is adequate for scaphoid subluxation alone, but combined dorsal plus volar approaches should be used for volar subluxation of the lunate with rotary subluxation of the scaphoid. Best results are achieved with open reduction as soon after the injury as possible. Factors in this series which were associated with poorer results were volar dislocation of the proximal pole of the scaphoid with the lunate, severely comminuted radial styloid fractures, extensive osteochondral fractures of the carpal bones, and late open reduction of rotary scaphoid subluxation. Based on their personal experience with 49 carpal dislocations in 46 patients, the authors suggest the following in the management of the acute injury: (1) Dorsal trans-scaphoid perilunate dislocation. After closed reduction, if the scaphoid is not anatomically reduced, primary open reduction and internal fixation with Kirschner wires is advised. A volar (Russe-type) approach gives adequate exposure, and bone grafting probably is not necessary. Satisfactory results can be achieved if the operation is done anytime within 2 weeks of injury. (2) Dorsal perilunate and volar lunate dislocation. Since cineradiographic studies show clearly that the lunate dislocation is usually the end stage of a perilunate dislocation, these injuries are treated identically after the initial closed reduction. Indications for open reduction are rotary subluxation of the scaphoid or lunate instability (dorsiflexion instability or volar subluxation). A dorsal approach is adequate for scaphoid subluxation alone, but combined dorsal plus volar approaches should be used for volar subluxation of the lunate with rotary subluxation of the scaphoid. Best results are achieved with open reduction as soon after the injury as possible. Factors in this series which were associated with poorer results were volar dislocation of the proximal pole of the scaphoid with the lunate, severely comminuted radial styloid fractures, extensive osteochondral fractures of the carpal bones, and late open reduction of rotary scaphoid subluxation.