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When Anatomy Protects: An aberrant Flexor Carpi Ulnaris muscle shielding the ulnar nerve after glass laceration
Poster
Talk Description

Institution: Fiona Stanley Hospital - WA, Australia

Introduction: Muscular variations within the flexor compartment of the forearm are uncommon and may result in diverse clinical presentations. Anomalies of the flexor carpi ulnaris (FCU) muscle are particularly rare, with reported prevalence ranging from 0.02% to 2%. Variations in the anterior compartment of the forearm have been associated with compression of the ulnar nerve and artery and may mimic soft tissue tumours or neuromas. While most reported cases highlight pathological consequences of such anomalies, their potential protective role in traumatic injuries is infrequently described. We present a unique case of an aberrant FCU muscle that provided protection to the ulnar neurovascular bundle following penetrating trauma. Case Presentation: A 54-year-old man presented to the emergency department following a fall through a glass door, sustaining a near-circumferential laceration to the volar aspect of the forearm consistent with a flexor zone V injury. Given the mechanism and extent of the wound, there was significant concern for underlying tendon and neurovascular injury. The patient was taken emergently to theatre for formal wound exploration. Intraoperatively, an anatomical variation of the FCU was identified, consisting of a small, separate muscle belly lying deep to the main FCU muscle. The laceration extended through this aberrant muscle belly, which was found to be directly overlying the ulnar artery and nerve. Despite the depth and severity of the injury, the ulnar neurovascular bundle remained intact, having been shielded by the anomalous muscle. Conclusion: This case demonstrates a rare anatomical variation of the FCU muscle that conferred a protective effect against ulnar nerve and artery injury in the setting of penetrating forearm trauma. Awareness of such anatomical variants is important for surgeons performing exploration of forearm injuries, as they may alter both injury patterns and surgical anatomy. This report highlights that, in rare cases, muscular anomalies may serve a beneficial role in traumatic settings.
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Dr Gabrielle Croker - , Dr Daniel Ricciardello - , Dr Samantha Valvis -

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