Lunate dislocations and perilunate fracture dislocations represent a spectrum of injuries involving the ligamentous attachments of the lunate bone. In a wrist hyperextension injury, mechanical failure frequently begins at the proximal radial wrist, either as a scaphoid fracture or as a scapholunate ligament disruption. Depending on the energy of injury, this initial location of injury will progress from radial to ulnar around the lunate. The path of injury may be entirely through ligaments, progressively disrupting the scapholunate, midcarpal and lunotriquetral joints, resulting in a lunate dislocation (Fig. 15a), or may pass through the radius, scaphoid, capitate or involve less common patterns of perilunate fracture dislocation (Fig. 15b). Many perilunate dislocations can be reduced closed, but all should have open ligament repair, often requiring a combined dorsal and palmar approach.