Perilunate dislocations and perilunate fracture-dislocations are marked by a wide range of high energy trauma to the wrist. Chronic perilunate injuries are defined by a treatment delay of at least 6 weeks. This systematic review aims to compare the various operative techniques and outcomes for chronic perilunate injuries. A systematic review of literature on chronic perilunate dislocations and perilunate fracture-dislocations were performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis statement guidelines using PubMed, Embase, Scopus, and Web of Science. A total of 326 articles were included, of which ultimately comprised of 13 articles with 158 patients. We demonstrate a rate of 59% perilunate fracture-dislocations, 30% perilunate dislocations, and 11% lunate dislocations. Mechanisms of injury were mostly high energy falls (31%) and motor vehicle accidents (50%). Fifty percent of patients had median nerve symptoms/paresthesias at time of initial presentation. Surgical technique included proximal row carpectomy (34%), open reduction internal fixation (49%), scaphoid excision with four corner fusion (7%), wrist arthrodesis (2%), partial lunate/scaphoid excision (1%), total lunate excision (5%), and isolated carpal tunnel release (1%). Average follow-up of time was 5 years. There was a 28% incidence of radiologic osteoarthritis at final follow-up with only 3 patients undergoing conversion to total wrist arthrodesis. Regardless of surgical technique, patients experienced improved levels of pain with a low reoperation rate, but decreased wrist range of motion and grip strength post-operatively.