A penetrating ear injury with a perilymphatic fistula is not an uncommon occurrence in otolaryngologic practice, but stapes luxation is rare. We report the case of an 11-year-old boy who developed a traumatic perilymphatic fistula secondary to an atypical stapes luxation into the vestibule. After sustaining a penetrating injury to the right ear, the patient presented with otalgia, vertigo, vomiting, gait unsteadiness, and hearing loss. High-resolution computed tomography (HRCT) of the temporal bone detected pneumolabyrinth, indicating a perilymphatic fistula. The stapes had pivoted on the footplate at the oval window, and then it made an unusual 180° flip and luxated deeply into the vestibule, with the capitulum stapedis pointing medially. Conservative management was chosen in view of the high surgical risks posed by the deeply luxated stapes and the likelihood of a fracture of the stapes footplate. This case illustrates the importance of an accurate diagnosis and interpretation of a traumatic perilymphatic fistula and stapes luxation as seen on HRCT of the temporal bone.