YALE JOURNAL OF BIOLOGY AND MEDICINE 81 (2008), pp.115-119. Copyright © 2008. CASE REPORT An Unusual Log-splitter Injury Leading to Radial Artery Thrombosis, Ulnar Artery Laceration, and Scapholunate Dissociation Christopher R. Spock, BA, Jeffrey C. Salomon, MD, Deepak Narayan, MD* Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut A log splitter is a gasoline- or diesel-powered machine that uses a hydraulic-powered cutting wedge to do the work of an axe. Log-splitter injuries that do not result in amputation of digits or limbs are uncommon and not well described in the literature. We present a unique case of a patient who sustained a log-splitter injury that resulted in thrombosis of the radial artery and avulsion laceration of the ulnar artery leading to acute hand ischemia, in addition to scapholunate ligament disruption leading to a DISI deformity. In this case, thrombolytic ther- apy was contraindicated and surgical revascularization was the best possible treatment op- tion. Our case illustrates the pitfalls of using this modality in a crush injury, since the use of thrombolytics in this instance would have resulted in severe hemorrhage. An important clin- ical caveat is the potentially misleading arteriographic diagnosis of thrombosis and/or spasm. INTRODUCTION Log-splitter injuries that do not result in amputation of digits or limbs are uncom- mon. The pressure generated by a log split- ter, upward of 13.5 meganewtons per square meter [1], is more than enough to cause amputation as well as severe crush injury. Traditionally, severe crush to the hand has been associated with a poor func- tional outcome [2,3]. In the typical case, one can expect metacarpal fractures, ragged skin flaps, and an unusually high incidence of compartment syndromes [4]. In addition to damage to skin and bone, vascular com- promise can be an important characteristic of such injuries. Acute post-traumatic hand ischemia is an emergency requiring an im- mediate attempt at revascularization. Gar- cia-Elias et al., from a review of the literature, recognized a sub-group of hand injuries with a concomitant vascular injury in which hand amputation was the end point of treatment if urgent vascular recon- struction was not carried out [5]. These in- juries, however, usually can be salvaged, provided that vascularity is maintained or restored. *To whom all correspondence should be addressed: Deepak Narayan, MD, Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520-8062; Tele: 203-785-2573; Fax: 203-785-5714; E-mail: deepak.narayan@yale.edu. †Abbreviations: tPA, tissue plasinogen activator; DISI, dorsal intercalated segment instability; DRC, dorsal radiocapitate. 115