As many as one-quarter of Perilunate injury cases are missed initially, prompt recognition of perilunate injuries is critical. Radiographs should be scrutinized for perilunate injuries. On the AP there will be a break in Gilula’s arcs, which are normal smooth articulations of the radiocarpal and midcarpal joint. Additionally, the lunate and capitate will abnormally overlap and the lunate will have a triangular appearance. On the lateral, the lunate will be completely volar to the capitate and the rest of the carpus. Once diagnosed, a closed reduction should be attempted, particularly if the patient has acute carpal tunnel syndrome (ACTS). The reduction is obtained typically by extending the wrist, applying axial traction, and then flexing the wrist while applying dorsal pressure over the carpus. Surgical management requires an open CTR in the setting of ACTS, followed by an open reduction, stabilization with pins, and SL ligament repair.