116 Spock: Unusual log-splitter injury Figure 1. Left Hand Arteriogram We present a case of a patient who sus- tained an unusual combination of injuries from a log-splitter accident. The important features of the patient’s injuries were throm- bus occlusion of the radial artery, an avul- sion disruption of the ulnar artery, and disruption of the scapholunate ligament leading to dorsal intercalated segment insta- bility (DISI) deformity. CASE REPORT A 39-year-old right master-handed gen- tleman presented approximately 20 hours after sustaining a crush injury to his left non- master hand in a log splitter at home. His past medical history was significant for hy- pertension. The patient initially was seen at a neigh- boring institution for evaluation and treat- ment. The physical exam on transfer revealed bruising of the distal volar forearm just proximal to the wrist without skin lacer- ation. Radial and ulnar pulses were lacking distal to the area of injury. Clinically, the hand was cool, slightly blue, and lacked dig- ital pulp turgor. Plain X-ray revealed pisi- form fracture and scapholunate dissociation. The patient underwent emergency an- giogram, which revealed abrupt cutoff of ra- dial and ulnar artery flow into the left hand at the level of the distal forearm just proxi- mal to the wrist junction. There was no evi- dence of extravasation of dye (Figure 1). Radiologic interpretation was felt to be con- sistent with ulnar and radial artery spasm. The patient was not felt to be a candidate for tissue plasminogen activator (tPA†), given the nature of his injuries. Since the patient showed no improvement on IV Heparin and the hand remained mottled and cool, emer- gent surgical exploration was recommended and accepted. Fasciotomies were performed on the volar forearm, the thenar eminence, and the inter-metacarpal regions in conjunction with a carpal tunnel release. Additionally, a Guyon’s canal release also was performed. The median and ulnar nerves were both in- tact. The ulnar artery was severely bruised and thrombosed over a length of 8 cm, ex- tending from the ulnar aspect of the superfi- cial palmar arch to 2 cm proximal to the volar wrist crease. At that level in the distal