Spock: Unusual log-splitter injury 119 with a severe hyperextension injury of the wrist, there is tear of scapholunate in- terosseous ligament. Further loading of the extended carpus causes tear, in succession, of radiocapitate ligaments, radiotriquetral ligaments, and, finally, dorsal radiocarpal ligaments. The lunate follows the triquetrum into extension and a DISI deformity results [11]. Mechanical properties of the dorsal lig- aments of the wrist have been reported. The strongest ligaments are the palmar radiotri- quetral ligament and the dorsal radiocapitate (DRC) ligament [12]. A study by Viegas et al. demonstrated that the dorsal intercarpal ligaments and dorsal scapholunate in- terosseous ligaments combined have a me- chanical strength (162.4 +/- 64.7 N) that is comparable to that of the DRC ligament (143.3 +/- 41.5 N) [13]. The force generated by a log splitter is more than enough to cause rupture of these ligaments. In summary, we present the case of an unusual 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 defor- mity. In this case, thrombolytic therapy was contraindicated, and surgical revasculariza- tion was the best possible treatment option. Our case illustrates the pitfalls of using this modality in a crush injury, since the use of thrombolytics in this instance would have re- sulted in severe hemorrhage. An important clinical caveat is the potentially misleading arteriographic diagnosis of thrombosis and or spasm. Clinicians, therefore, should be cau- tious about accepting a diagnosis of spasm or thrombosis and using thrombolytics in their approach to these unusual injuries. REFERENCES 1. Kristiansen TK, Seligson D. Log splitter in- juries to the hand. Journal of Occupational Medicine. 1981;23(6):400-2. 2. Carter PR. Crush injury of the upper limb. Early and late management. Orthop Clin North Am. 1983;14(4):719-47. 3. Entin MA. Crushing and Avulsing Injuries of the Hand. Surg Clin North Am. 1964;44:1009-18. 4. Del Pinal F, Herrero F, Jado E, et al. Acute hand compartment syndromes after closed crush: a reappraisal. Plast Reconstr Surg. 2002;110(5):1232-9. 5. Garcia-Elias M, Dobyns JH, Cooney III WP, Linscheid RL. Traumatic axial dislocations of the carpus. J Hand Surg. 1989;14(3):446- 57. 6. May JW Jr., Hansen R. Log-splitter injuries. N Engl J Med. 1980;303(19):1127. 7. Kartchner MM, Wilcox WC. Thrombolysis of palmar and digital arterial thrombosis by intra-arterial Thrombolysin. J Hand Surg. 1976;1(1):67-74. 8. Lambiase RE, Paolella LP, Haas RA, Dorf- man GS. Extensive thromboembolic disease of the hand and forearm: treatment with thrombolytic therapy. J Vasc Interv Radiol. 1991;2(2):201-8. 9. Wheatley MJ, Marx MV. The use of intra-ar- terial urokinase in the management of hand ischemia secondary to palmar and digital ar- terial occlusion. Ann Plast Surg. 1996;37(4):356-63. 10. Wheatley MJ, Swift R. Successful hand revascularization with urokinase following a crush injury. Ann Plast Surg. 1997;39(1):94- 6. 11. Mayfield JK. Mechanism of carpal injuries. Clin Orthop. 1980;149:45-54. 12. Savelberg HH, Kooloos JG, Huiskes R, Kauer JM. Stiffness of the ligaments of the human wrist joint. J Biomech. 1992;25(4):369-76. 13. Viegas SF, Yamaguchi S, Boyd NL, Patterson RM. The dorsal ligaments of the wrist: anatomy, mechanical properties, and func- tion. J Hand Surg. 1999;24(3):456-68.