Perilunate wrist injuries are relatively rare but devastating injuries that can alter the lifestyles of those sustaining them. It is important to recognize the magnitude of the injury and to provide immediate and complete care to the patient. Two of the most important factors affecting outcomes are timing of the care provided and quality of the reduction and carpal alignment following definitive management. This review explores the anatomy, pathoanatomy, and biomechanics, as well as the diagnoses and different treatment options for perilunate wrist injuries available to date and their complications and outcomes.