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A patient in their 30s presented with a 7 cm deep laceration to the distal right volar forearm after falling 4 feet from a ladder onto corrugated sheet metal while working on a roof at their job. The patient initially presented to an outside hospital at approximately 1000 hours and arrived at our emergency room at 1024 hours. The actual time of the injury was not known, but we suspected the injury occurred around 0700 hours. The patient was hemodynamically stable on arrival and had a pressure dressing in place. There was an absence of radial and ulnar pulses in the affected limb. Of note, the patient’s hand was fully extended, and they could not flex their hand, indicating involvement of the flexor tendons. On removal of the pressure dressing, there was obvious pulsatile arterial bleeding from the patient’s wrist. This patient presented at a level 1 community-academic hybrid trauma center and was treated by a fellowship-trained trauma surgeon.