A perilunate dislocation is an orthopaedic emergency that is commonly missed in the acute setting owing to the rarity of this presentation. The mechanism is usually wrist hyperextension with a degree of ulnar deviation in the setting of high energy trauma.¹ Scaphoid fractures can be associated with these injuries in up to 61% of cases.¹ Furthermore, acute median nerve compression is common.²

This patient presented with increased pain, swelling and altered sensation of the right wrist/hand in a median nerve distribution three days post right-sided fall onto outstretched hand (FOOSH) following a motorcycle accident. Unfortunately, images in the acute setting are not available. Initially diagnosed and treated as a triquetral fracture with a short-arm backslab. Subsequent imaging revealed a trans-scaphoid perilunate dislocation. Median nerve decompression was performed urgently along with open reduction and internal fixation of the scaphoid with K-wire stabilisation between the lunate and triquetrum.