Wrist arthroscopy has become a reliable technique for the management of distal radius fractures (DRF) and perilunate injuries (PLI). Wrist arthroscopy provides a comprehensive visualization of the radiocarpal and midcarpal joints with a few mini-invasive portals. Dry arthroscopy has facilitated combinations of open and arthroscopic management (so-called arthroscopically assisted reduction and internal fixation, AARIF). Pure wrist arthroscopic management (arthroscopic reduction and internal fixation, ARIF) may be used in selected PLI. The authors focus on the role of AARIF and ARIF for acute distal radius fractures and perilunate injuries.