What follow-up is recommended for an adult patient 12 weeks post left scaphoid fracture with near-complete osseous union and minimal residual fracture line?

Follow-Up Recommendations for Near-Complete Scaphoid Union at 12 Weeks

For a scaphoid fracture at 12 weeks with near-complete osseous union and minimal residual fracture line, discharge from imaging follow-up and begin progressive mobilization and strengthening, as most patients are followed clinically until pain-free and can increase activity in a controlled manner without additional imaging. 1

Clinical Management Pathway

Immediate Next Steps

• No additional imaging is required if the patient is asymptomatic and radiographs demonstrate near-complete union with trabecular bridging 1
• Clinical follow-up should focus on pain-free status and functional restoration rather than repeat imaging 1
• Begin controlled progressive activity and strengthening exercises once the patient is pain-free 1

When Additional Imaging IS Indicated

Additional imaging should only be obtained if specific complications are suspected 1:

• CT without IV contrast if there is unexpected incomplete response to conservative therapy with return of symptoms after increasing activity 1
• MRI without IV contrast if clinical concern develops for osteonecrosis, particularly in proximal pole fractures 1, 2
• CT without IV contrast to definitively confirm complete trabecular bridging if clinical uncertainty exists about union status 1

Criteria for Discharge from Care

The American College of Radiology guidelines support clinical follow-up without routine imaging once union is progressing appropriately 1. Specifically:

• Patient should be pain-free with activities of daily living 1
• No tenderness over the scaphoid tubercle or anatomic snuffbox on examination 2
• Radiographic evidence of trabecular bridging (at least 50% continuous trabecular bridging is sufficient for mobilization) 3

Return to Full Activity

• Patients can progressively increase activity in a controlled manner once pain-free 1
• For athletes or high-demand patients, ensure complete radiographic union before return to contact sports or high-risk activities 4
• Most patients return to pre-injury activity levels once union is achieved 5

Critical Pitfalls to Avoid

Do not order routine follow-up imaging at this stage unless symptoms recur or new clinical concerns arise, as this represents overutilization without evidence of benefit 1. The key distinction is that after diagnosis of healing fracture, additional imaging is typically not needed and patients are followed clinically 1.

Do not restrict activity indefinitely - prolonged immobilization beyond the point of adequate union can lead to stiffness and decreased quality of life without improving outcomes 6, 3.

Monitor for delayed complications only if symptoms develop, including persistent pain (suggesting nonunion or osteonecrosis), decreased grip strength, or limited range of motion 1, 2. In these scenarios, CT or MRI would then be appropriate to evaluate for complications 1.