We report 4 cases of chronic trans-scaphoid perilunate dislocation. The mean age of the patients at operation was 27 years and the mean period between injury and operation was 10 months. One case which had been unreduced for 2 years 10 months was treated by proximal row carpectomy, the others by open reduction with a bone graft using the Russe technique. The duration of follow-up ranged from 1 year 5 months to 7 years 10 months. Patients were clinically evaluated using the scoring system reported by Nagoya Universily. All 4 cases had good results (points from 70 to 80), although 2 cases showed DISI radiographically. Old transscaphoid perilunate dislocations should first be treated by open reduction with a bone graft using the Russe technique, since closed reduction is usually impossible. If open reduction fails or the clinical course is not good, other methods including proximal row carpectomy are recommended.