Transscapho-transcapitate fracture dislocation of the carpus is a rare form of perilunate dislocation. It occurs after acute high-energy hyperdorsiflexion trauma and longitudinal compression of the wrist, with concurrent fractures of the scaphoid and capitate neck and rotation of the proximal fragment of the capitate up to 180 degrees. Four cases and their treatments are described, and the literature is reviewed. A possible explanation of the mechanism underlying this condition is offered, and methods of treatment are discussed. If a stable anatomic situation is not obtained with closed reduction, surgical reduction and internal fixation of the scaphoid and capitate bones are recommended to prevent loss of function.