We report 22 patients who sustained a perilunate dislocation (PD) with or without a fracture of the scaphoid. The carpal ligaments were explored and reattached in all cases. The fractured scaphoid in perilunate fracture dislocations (PFD) was stabilised by a Herbert screw in 13 cases and in one case with a Matti-Russe bone graft. After an average of 5 years the clinical score of Green and O'Brien showed good results for both PD and PFD. Patients with PFD had less pain and better grip than the patients with PD. The sagittal range of motion (average between 70 degrees and 99 degrees) and the subjective limitation in sports and work were equal for PD and PFD. The only open injury (PD) had the worst clinical result. All patients with PD showed a carpal instability dissociative of the proximal row (CID) and an arthrosis of the radiocarpal joint. In the patients with PFD a CID could be seen in 78% and an arthrosis in 93%. A carpal collapse occurred in 75% of cases after PD and in 29% after PFD. In 57% of cases the PFD was accompanied by a disruption of the SL ligament. The anatomical reconstruction of the scaphoid is essential for good carpal alignment. The stable fixation of bony avulsions showed good results. A CID could not be avoided in any of our patients with PD.