Perilunar dislocations lead to important capsuloligamentous lesions associated with osteochondral fractures which jeopardize carpal stability if non treated operatively. Aside from the classical mechanism in which the lesions start on the radial side, the author considers the possibility of perilunar dislocations which may begin by lunotriquetral dissociation. Post-reduction carpal instability is more frequent in pure dislocations than in those with associated fracture of the scaphoid. An anterior and posterior double approach is often necessary in order to ensure exact reduction and stability in a correct position.