21 year old male (CB) presenting with left scapho-trapezio-trapezoid (STT) joint dislocation after a road traffic crash. The patient was at a T-junction travelling about 40 km/h and was t-boned by another car on the driver’s side and his 1st webspace got caught on the steering wheel. Onexamination at the urgent care, he had a tender anatomical snuff box area, with no open wounds and otherwise neurovascularly intact. Xrays on the day of injury were reported as no acute fracture or malignment. The patient was not casted at this point. CB then re-presented to urgent care two weeks after the injury with ongoing pain in his wrist. The xray taken at this point was reported to have widening of the scapholunate interval. A CT scan was done in response that demonstrated widening of scapholunate interval suspicious for scapholunate injury as well as abnormal lunate tilt suspicious for a volar intercalated segmented instability (VISI) deformity. The patient proceeded to have Left STT joint open reduction + K-wire stabilisation 3-weeks post injury. Dorsal incision over the base of the first CMCJ between the second and third extensor compartments. Location of the STT joint confirmed with hypodermic needle and mini-C arm guidance. A T-shaped capsulotomy created over STT joint. With dorsal pressure and traction on the thumb the lunate was reduced appropriately. With volar pressure the lunate dislocated and demonstrated gross instability. A 2.0mm K-wire was first passed from the trapezoid into the scaphoid through the open dorsal wound. A percutaneous volar 1.6mm Kw-ire was then placed from the trapezium into the distal scaphoid. Under mini-c arm guidance the DISI deformity was identified to have been corrected by reduction of the STT joint and reduction was again confirmed. Patient put into below elbow thumb spica for an 8-weeks period before commencing hand therapy. This is a very rare case that can be misdiagnosed on xrays if not investigated further with advanced imaging.