Perilunate dislocations and fracture-dislocations are considered rare injuries. Perilunate injuries are frequently missed during primary evaluations. We report a case of a 37-year-old male presenting with an open perilunate fracture-dislocation a few days after experiencing trauma. He underwent repeated debridements, and provisional external fixator application followed by a definitive open reduction through a combined dual approach and internal fixation of scaphoid and capitate with headless screws. Aggressive physiotherapy exercises were started eight weeks after definitive fixation. After six years, the patient had a satisfactory outcome with an excellent Mayo wrist score. Perilunate injuries should be considered one of the important differential diagnoses in wrist injuries. Early diagnosis and treatment are of utmost importance to gain optimum outcomes. The best results could be achieved with open reduction and internal fixation through a combined volar and dorsal approach.