118 Spock: Unusual log-splitter injury Figure 3. Post-operative MRI search using both keywords and titles, in- cluding “log splitter,” reveals only two arti- cles [1,6]. While there is no characteristic “log splitter hand,” the most common result- ant injuries are complete or partial loss of digits, fracture(s) with soft tissue loss, or both [1]. Often, the crushing nature of the injury precludes successful replantation of amputated parts. The unique features of this particular in- jury include a complete avulsion/traction rupture of the ulnar artery in the distal fore- arm in a closed injury and a trans-scaphoid dislocation with the proximal pole of the scaphoid and capitate both dorsal to the lu- nate, consistent with a dorsal intercalated segment instability (DISI) deformity. We postulate that this injury was caused by the rapid forceful radial deviation and extension of the wrist, hence the rupture of the ulnar artery, by the patient attempting to extricate himself from the log splitter in which his hand was pinned. In the case we report, the angiogram demonstrated an abrupt cutoff of the radial and ulnar arterial inflow to the hand at the level of the wrist. Initial radiographic im- pression was vascular spasm vs. thrombosis or a combination of both, simultaneously in- volving both the radial and ulnar arteries. The angiographer did not feel that the pa- tient was a candidate for thrombolytic treat- ment because the nature of the injury posed a bleeding risk. In certain cases, throm- bolytic therapy has been useful in the man- agement of thrombotic and embolic hand is- chemia [7-10], but little information exists on thrombolysis in the setting of an acute crush injury. Wheatley and Swift report a case of successful hand revascularization using urokinase following crush injury [10]. In that particular case report, there was ab- sence of distal vessel reconstitution in the palmar arch and digital vasculature. To our knowledge, a case of arterial thrombosis and concomitant arterial avul- sion and laceration resulting in complete loss of blood flow to the hand following this type of injury has not been reported. In ad- dition to the vascular injury, the patient sus- tained scapholunate ligament disruption, rotary subluxation of the scaphoid, and dor- sal tilt of the lunate consistent with a dorsal intercalated segment instability (DISI) de- formity. We postulate that our patient suffered the ulnar artery disruption while forcefully torquing his arm and body in an effort to quickly extricate his hand from under the log in the log splitter. Without force sufficient to disrupt the distal radial-ulnar joint and tear the triangular fibrocartilage complex and scapholunate ligaments, it would be unlikely that the wrist could radially deviate suffi- ciently from the axis of the forearm to allow sufficient stretch on the ulnar artery to allow it to rupture. In effect, we believe that the patient sustained a flash proximal carpal row dislocation into complete radial deviation. The scapholunate disruption initially was not pinned because restoration of blood flow to the ischemic hand was of primary importance. Once blood flow was restored and the hand was viable, the decision was made not to pin the scapholunate disruption at that time. We did not want to manipulate the fresh anastomosis of the saphenous vein graft or risk damaging the vessel through pinning. The mechanism of a scapholunate dis- ruption is similar to that of a scaphoid frac- ture, which is characterized by stress loading of the extended carpus. However, in a scapholunate disruption, the wrist is usually in ulnar, rather than radial, deviation, and