Lunate fractures associated with perilunate dislocation are very rare.The diagnosis is often difficult as is the treatment itself.Up to 25% go on to be undiagnosed in the emergency room (ER) setting.We present 3 very different cases of perilunate dislocation with lunate volar lip fracture occurring in the different hospitals around the world (Spain, Colombia and Chile).All 3 were diagnosed in the ER, however the treatments differ.We aim to show the spectrum of treatment of these high energy lesions either acute or chronic and the outcomes of these.