Osteo-articular disorders of the hand and aptitude for work: Aseptic osteonecrosis of the lunate (Kienbock's disease) and disability « about a case ».

Abstract

Introduction: The hand is frequently the site of work accidents. Occupational exposure to iterative microtrauma can cause Kienböck's syndrome and carpal osteoarthritis. The functional discomfort caused by these impairments can lead to a lasting disability, a source of unfitness for work.

Patient methods: This is a 50-year-old woman, employed in the post office, victim of a work accident, following a slip, which resulted in a poorly consolidated fracture of the left wrist. The diagnosis retained was in favor of Kienböck's disease, for which the emergency orthopedic treatment was content with a compression splint and provided for arthrodesis, in view of the risk of major evolution towards ankylosis and deformation of the hand in claw (poor prognosis).

Results and discussions: Working conditions: the patient is constrained in his workstation to pronation movements, flexion of the fingers, repetitive flexion of the left hand (left-handed +++), manipulating an automatic tool in order to introduce the codes of the courier to the file computer (Very high rate around 400 letters / day).

Conclusion: Many hand pathologies related to professional activity can benefit from a declaration as an occupational disease, allowing the patient to obtain compensation and job protection. The prevention of work-related hand injuries must be implemented by all health actors, particularly for professions and sectors of activity at risk. The occupational physician is a privileged interlocutor for assistance in maintaining the workplace.