5 Stages of Bone Healing Process |Fracture classification |5 P’s - Nurseship.com (2023)

In this article, you will review the types/classifications of fractures, 5 stages of bone healing process, and 5 P’s in nursing assessment of a patient with a fracture.

Also, you will learn about factors affecting bone healing, causes of fracture, signs, and symptoms, and complications.

What is a fracture in nursing?

A fracture is a traumatic break of the continuity of the bone. Fracture occurs when a bone is subjected to more stress than it can withstand.

Nursing care for fractures focuses on patient safety, preventing further injury, relieving pain, assisting with self-care, education, and promoting rehabilitative efforts to regain mobility and function.


Fracture is defined as a complete or incomplete disruption in the continuity of bone structure and is classified according to its type and extent.

What are the types/classification of fractures?

There are many types of fractures. And classification of fractures is also done in several ways.

A fracture can be classified based on the extent of the break. i.e.,

  • Complete fracture (bone is completely separated at the point of fracture)
  • Incomplete fracture (bone is partially separated at the point of fracture)

A fracture is also classified based on the degree of underlying soft tissue damage. i.e.,

  • Closed fracture (or simple fracture): Fracture is enclosed inside skin tissue and has no visible wound.
  • Open fracture (or compound fracture): Fracture penetrates the skin surface and the wound is visible at the site of injury.

Additionally, classification of fractures is done according to their cause. i.e.,

  • Pathologic fracture (or spontaneous fracture): Occurs when bones become weak as a result of disease, such as metastatic cancer.
  • Fatigue fracture (or stress fracture): Occurs due to repetitive stress. Commonly seen in athletes.
  • Compression fracture: a fracture caused by pressing two bones together. They are extremely painful and commonly occur in the vertebrae of older patients with osteoporosis.

Following are the types of fractures based on their pattern of break.

  1. Spiral/ torsion fracture: Caused by twisting motion
  2. Greenstick fracture: Complete fracture on one side of the bone, and a bend on the other. Usually occur in children.
  3. Oblique fracture: Angular fracture (diagonal) line across a bone.
  4. Transverse fracture: Break across the bone, with the fracture at a right angle with the long axis of a bone.
  5. Linear fracture: Break along the vertical axis of the bone.
  6. Dislocation: Simultaneous occurrence of both fracture and dislocation.
  7. Comminuted/multi-fragmentary: Bone broken into more than three fragments, with no contact between distal and proximal fragments.
  8. Depressed fracture: Fragments are driven inwards; this happens mostly with fractures of the skull and facial bones.
  9. Avulsion fracture: A fragment of the bone is torn away, as seen with accidents that involve the tendon.
  10. Impacted fracture: occurs when bone fragments are wedged into other bone fragments.

In children, fracture is classified according to anatomical position. They include:

  • Physis: the growth plate of a bone found in children, factures on this area are referred to as “physeal fractures
  • Epiphysis: Distal bone surface, that articulates with the joint, fractures occurring in the epiphysis are called “epiphyseal fractures
  • Metaphysis: Found between the epiphysis and shaft, and form a flare-like shape. Fractures in this area are referred to as “metaphyseal fractures
  • Diaphysis: The shaft of the long bone. Fractures in this area are referred to as “diaphyseal fractures”. They can either be proximal, middle, or distal.

5 Stages of bone healing process

When a bone is fractured, the body immediately begins the healing process. The process of bone healing is described in several ways.

5 Stages of Bone Healing Process |Fracture classification |5 P’s - Nurseship.com (1)

For example, the bone healing process is sometimes described in three phases as well. They are:

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  • Inflammatory phase [initial 4 weeks];
  • Repair phase [1–2 months]; and
  • Remodeling phase [up to 12 months].

Following are the five stages of bone healing process in chronological order.

Bone healing process: Stage 1

Stage one is from 1-3 days after the injury. During this stage a hematoma forms at the site of the fracture.

Bone healing process: Stage 2

Stage two of bone healing occurs within 3 days to 3 weeks. During this stage granulation tissue begins to invade the hematoma.

This causes the formation of fibrocartilage, which serves as the foundation for bone healing.

Bone healing process: Stage 3

Stage three of bone healing occurs within 3 to 6 weeks after the injury. During this stage, vascular and cellular proliferation takes place, causing the formation of fibrocartilaginous callus.

The formation of new vascular tissue at the site of the fracture is called Callus. A nonbony union starts with soft callus formation.

Bone healing process: Stage 4

The fourth stage of the bone healing process lasts anywhere between 3 to 8 weeks.

At this stage, endochondral ossification (callus calcification process) takes place.

In which, the fibrocartilaginous callus is gradually replaced by mature bone, and the extra callus is gradually reabsorbed by osteoclasts.

Bone healing process: Stage 5

Stage five completes the bone healing process by remodeling and consolidating the fractured bone.

The final stage may start as early as 4 to 6 weeks after the fracture and can last up to a year.

The duration will depend on the severity of the injury, age, and general health of the patient.

5 Stages of Bone Healing Process |Fracture classification |5 P’s - Nurseship.com (2)

What are the factors affecting bone healing?

Some of the factors affecting bone healing include:

  • Age (bone heals faster in children while it is delayed in adults over 45 years)
  • Presence of chronic diseases (such as HIV, diabetes, and cancer)
  • Alcohol use
  • Postmenopausal women
  • Low body mass index (BMI)
  • Malnutrition
  • Smoking
  • Use for certain medications (such as glucocorticoids)
  • Infection
  • Malignancy
  • Misalignment
  • Inadequate or improper immolation
  • Avascular necrosis
  • Bone loss

What are the five P’s in nursing assessment of a patient with a fracture?

Five P’s are acronyms used in the neurovascular assessment. The 5 P’s stands for Pain, Pulse, Pallor, Paresthesia, and Paralysis.

Nurses use the 5 P’s to assess fracture patients’ peripheral tissue perfusion and early detection of compartment syndrome.

Compartment syndrome is a complication of fracture which requires immediate medical attention. Because it can result in permanent muscle and nerve damage, as well as death.

paresthesia (nerve damage) and paralysis (disruption of nerves)

5 Stages of Bone Healing Process |Fracture classification |5 P’s - Nurseship.com (3)

1. Pain

Assess pain using a pain assessment tool such as OLD CARTS. Also, use a standardized tool to determine the severity of the pain perceived by the patient.

2. Pulse

Assess the characteristics of the pulse distal to the fracture for quality, rate, and rhythm. Grade the pulse using a scale from 0 to 4+ (0 indicates no pulse and 4+ indicates bounding pulse).

See pulse grading scale.

3. Pallor

Pallor or paleness distal to the fracture indicates reduced blood flow. When the blood flow is interrupted, skin discoloration (bluish or purplish) and increased capillary refill can be observed.

4. Paresthesia

Paresthesia indicates damage to the nerves. The patient may complain of numbness, tingling, or pin or needles pricking sensation injured limb.

5. Paralysis

Paralysis is defined as the inability to move a fractured limb.

What are the causes of fractures?

Some of the causes of fracture include:

  • Trauma (such as road traffic accidents, blunt/penetrating injuries, falls, sports-related injuries, and natural disasters).
  • Osteoporosis (Which affects bone density. Spine, hip, and wrist fractures are common with osteoporosis).
  • Repetitive stress, associated with occupational and sports/athletics.
  • Malignant or benign bone tumors
  • Osteomyelitis

Signs and symptoms

Following are the signs and symptoms of fracture.

  • Pain
  • Loss of function
  • Deformity
  • Swelling
  • Bleeding
  • Ecchymosis
  • Crepitus
  • Shortening of the affected limb

Complications of fracture

Complications can either be early or delayed.

Early complications include:

  • Hypovolemic shock
  • Rhabdomyolysis (breakdown of muscle tissue and subsequent release of myoglobin into circulation)
  • Fat embolism
  • Deep vein thrombosis (DVT)
  • Disseminated intravascular coagulation (DIC)
  • Bacterial infections
  • Compartment syndrome (a medical emergency)

Delayed complications include:

  • Complex regional pain syndrome (abnormally severe pain and reduced function that develops following injury)
  • Delayed union (healing taking longer than expected)
  • Malunion (bone healing but not in the right position)
  • Nonunion (ends of the fractured bone failing to unite)
  • Avascular necrosis
  • Osteomyelitis
  • Heterotrophic ossification


To sum up, 5 stages of bone healing process include (1) hematoma formation, (2) granulation tissue, (3) callus formation, (4) ossification, and (5) remodeling and consolidation of the bone.

The 5 P’s in nursing assessment of a patient with a fracture are (1) pain, (2) pulse, (3) pallor, (4) paresthesia, and (5) paralysis.


Hinkle, J., & Cheever, K. (2018).BRUNNER & SUDDARTH’S TEXTBOOK OF Medical-Surgical Nursing(14th ed.). Wolters Kluwer.

Hickman, R., Alfes, C. M., & Fitzpatrick, J. J. (2018). Handbook of clinical nursing. Medical surgical nursing. Springer.

Ignatavicius, D., Workman, M., Blair, M., Rebar, C., & Winkleman, C. (2016).Medical-Surgical Nursing Patient-Centered Collaborative Care(8th ed.). Elsevier.


What are the 5 stages of bone healing PDF? ›

There are 5 phases to bone healing: haematoma, inflammation, proliferation, callus formation, and remodelling.

What are the stages of bone healing process? ›

There are three stages of bone healing: the inflammatory, reparative, and remodeling stages.

What are the different classifications for fractures and stages of bone healing? ›

Fractures are classified by their complexity, location, and other features. Common types of fractures are transverse, oblique, spiral, comminuted, impacted, greenstick, open (or compound), and closed (or simple). Healing of fractures begins with the formation of a hematoma, followed by internal and external calli.

What are the stages of bone healing NCBI? ›

Fracture healing is commonly described as a 4-phase concept: 1) inflammation phase, 2) soft callus formation (cartilage form), 3) hard callus formation (woven bone), and 4) bone remodeling (Fig. 4).

What are the 5 stages of bone growth? ›

There are five phases in the bone remodeling process: ACTIVATION, RESORPTION, REVERSAL, FORMATION, and QUIESCENCE. The total process takes about 4 to 8 months, and occurs continually throughout our lives.

What are the 5 stages of bone remodeling? ›

The remodelling cycle occurs within the basic multicellular unit and comprises five co-ordinated steps; activation, resorption, reversal, formation and termination. These steps occur simultaneously but asynchronously at multiple different locations within the skeleton.

What is the first stage of bone healing? ›

The inflammatory phase, also called fracture hematoma formation, is the first stage of healing that occurs immediately after the injury. According to one study, approximately 48 hours after the injury, blood vessels torn by the fracture release blood. This blood starts to clot and forms a fracture hematoma.

In which order do the steps of bone healing occur quizlet? ›

  • stage one. fracture and inflammatory phase.
  • fracture and inflammatory phase. ...
  • stage two. ...
  • granulation tissue formation. ...
  • stage three. ...
  • callus formation. ...
  • stage four. ...
  • lamellar bone deposition.

What are the 4 steps to bone healing quizlet? ›

Terms in this set (4)
  • hematoma. when the bone breaks, blood vessels in the bone are torn and hemorrhage. ...
  • fibrocartilaginous callus. temporary formation of fibroblasts and chondroblasts which forms at the area of a bone fracture as the bone attempts to heal itself. ...
  • bony callus formation. ...
  • remodeling.

What are the classification of bone fractures? ›

Your provider will classify your fracture as either open or closed. If you have an open fracture, your bone breaks through your skin. Open fractures are sometimes referred to as compound fractures. Open fractures usually take longer to heal and have an increased risk of infections and other complications.

What are the classification of bones *? ›

How are they categorized? There are five types of bones in the skeleton: flat, long, short, irregular, and sesamoid.

What is primary healing of bone? ›

Primary bone healing is the reestablishment of the cortex without the formation of a callus. It occurs if a fracture is adequately "fixed" through reduction, immobilization, and rehabilitation. Secondary bone healing, as described above, occurs through the formation of a callus and subsequent remodeling.

What are the stages of bone healing Google Scholar? ›

Bone healing can be viewed as a three-stage biological phase (inflammation, repair, and remodeling) which can be further divided into six main sub-steps: hematoma, inflammation, soft callus formation, hard callus formation, remodeling, bone healing.

What are the steps of bone repair quizlet? ›

Terms in this set (5)
  • How many steps are there? Formation of fracture hematoma. ...
  • .1. Formation of fracture hematoma. ...
  • Fibrocartilage callus formation. (takes 3 weeks) ...
  • Bony Callus formation. (last 3-4 months) ...
  • Bone Remodeling.

What are the stages of bone? ›

Abstract. The process of bone formation is called osteogenesis or ossification. After progenitor cells form osteoblastic lines, they proceed with three stages of development of cell differentiation, called proliferation, maturation of matrix, and mineralization.

What are bones Grade 5? ›

Bones are composed of calcium, phosphorus, and a fibrous substance known as collagen. Bones are strong but light in weight as they are hollow from inside. The long bones of the arms and legs, such as the femur (thigh bone), have a central cavity containing bone marrow.

What are the 5 stages of endochondral ossification? ›

Endochondral ossification can be divided into five stages: commitment, compaction, proliferation, growth, and finally, chondrocyte death and the generation of new bone. Phases 1 and 2: commitment and compaction. First, the mesenchymal cells commit to becoming cartilage (Figure 1A).

What is the timeline of a broken bone healing? ›

How Long Does a Fracture Take to Heal? Most fractures heal in 6-8 weeks, but this varies tremendously from bone to bone and in each person based on many of the factors discussed above. Hand and wrist fractures often heal in 4-6 weeks whereas a tibia fracture may take 20 weeks or more.

What is the process of bone modeling? ›

Bone modeling describes the process whereby bones are shaped or reshaped by the independent action of osteoblast and osteoclasts. The activities of osteoblasts and osteoclasts are not necessarily coupled anatomically or temporally. Bone modeling defines skeletal development and growth but continues throughout life.

Which of the following lists the steps of bone repair in the correct sequence? ›

Answer and Explanation: Out of the options listed above, the one that pertains to the correct sequence of steps in the repair of a bone fracture is option (d) fracture hematoma, fibrocartilaginous callus formation, bony callus formation, bone remodelling.

What is the first stage in the healing of a bone fracture quizlet? ›

What is the first stage in the healing of a bone fracture? In order, what are the stages of bone fracture healing? formation of a hematoma, formation of a fibrocartilaginous callus, formation of a bony callus, and bone remodeling.

What is the first step of the fracture healing process quizlet? ›

First stage: bleeding creates hematoma, which surrounds the ends of the fragments. This occurs in the initial 72 hours after injury.

Which terms are used to identify a stage of wound healing in bone quizlet? ›

The steps, in order, for bone wound healing are hematoma formation, procallus formation, callus formation, callus replacement, and remodeling.

What are the five bone classifications describe each and give an example? ›

Sesamoid Bones
Bone classificationFeaturesExamples
ShortCube-like shape, approximately equal in length, width, and thicknessCarpals, tarsals
FlatThin and curvedSternum, ribs, scapulae, cranial bones
IrregularComplex shapeVertebrae, facial bones
SesamoidSmall and round; embedded in tendonsPatellae
1 more row
Apr 20, 2022

How many classifications of bone tissue are there? ›

There are two types of bone tissue: compact and spongy. The names imply that the two types differ in density, or how tightly the tissue is packed together.

What are the names and descriptions of five major types of fractures? ›

5 types of fractures you may experience
  • Open (compound) fracture. This type of fracture usually results from severe trauma, causing your broken bone to pierce the skin. ...
  • Stress fracture. ...
  • Comminuted fracture. ...
  • Greenstick fracture. ...
  • Compression fracture.

What are the 5 types of bones discuss the function of each bone? ›

They are usually classified into five types of bones that include the flat, long, short, irregular, and sesamoid bones. The human bones have a number of important functions in the body. Most importantly, they are responsible for somatic rigidity, structural outline, erect posture and movement (e.g. bipedal gait).

What are the 5 main parts of the skeletal system? ›

skeleton, Bony framework of the body. It includes the skull, vertebral column, collarbone, shoulder blades, rib cage, pelvic girdle and the bones of the hands, arms, feet, and legs. The skeleton supports the body and protects its internal organs.

What are the five types of bone quizlet? ›

Terms in this set (5)
  • Long Bones. These bones are longer than they are wide. ...
  • Short Bones. These are cube-like in appearance, being as long as they are wide. ...
  • Flat Bones. These are thin bones that function to protect the tissues and organs of the body. ...
  • Irregular Bones. These are irregular in shape. ...
  • Sesamoid Bone.

What are the four classifications of bones and give examples of each? ›

Bone types
  • Long bone – has a long, thin shape. Examples include the bones of the arms and legs (excluding the wrists, ankles and kneecaps). ...
  • Short bone – has a squat, cubed shape. ...
  • Flat bone – has a flattened, broad surface. ...
  • Irregular bone – has a shape that does not conform to the above three types.

What are the four classifications of bones quizlet? ›

Terms in this set (5)

The four major anatomical classifications of bones are long, short, flat, and irregular.

What are the types of healing? ›

Primary healing, delayed primary healing, and healing by secondary intention are the 3 main categories of wound healing. Even though different categories exist, the interactions of cellular and extracellular constituents are similar.

What is the most important factor in bone healing? ›

The most important factors in fracture healing are blood supply and soft-tissue health, and initial management of an injured limb should have the goal of maintaining or improving these.

What is healing and its types? ›

There are two main types of healing, primary intention and secondary intention. In both types, there are four stages which occur; haemostasis, inflammation, proliferation, and remodelling. In this article, we shall look the mechanisms of wound healing, factors affecting healing, and wound infection.

How many stages of healing are there? ›

The four phases of wound healing. The complicated mechanism of wound healing occurs in four phases: hemostasis, inflammation, proliferation, and remodelling.

What are the four main stages of healing that occur after a bone fracture? ›

Bone healing is a four-step process consisting of inflammation, repair, new bone formation, and bone remodeling (Figure 3) [2].
  • Figure 3 - Bone healing happens in four steps.
  • First, inflammation occurs after the injury. Then the bone is induced to repair and is forming soft callus.
Sep 8, 2021

What is the first step of bone repair quizlet? ›

First, the fracture hematoma is reorganized into an actively growing connective tissue called a procallus. Fibroblasts within the procallus produce collagen fibers that help connect the broken ends of the bones.

What is correct order of the steps of tissue repair quizlet? ›

  • 1)inflammation. Severed blood vessels bleed and inflammatory chemicals are released. ...
  • 2)Organization and restored blood supply. The blood clot is replaced with granulation tissue. ...
  • 3)regeneration and fibrosis.

Which of the following lists the steps of fracture repair in the correct sequence quizlet? ›

Which of the following correctly lists the steps of fracture repair in sequence? A hematoma forms, granulation tissue and fibrocartilage develop, osteoclasts and phagocytes clear away debris, bony callus forms.

How long until a bone is fully healed? ›

How Long Does a Fracture Take to Heal? Most fractures heal in 6-8 weeks, but this varies tremendously from bone to bone and in each person based on many of the factors discussed above. Hand and wrist fractures often heal in 4-6 weeks whereas a tibia fracture may take 20 weeks or more.

How do I know if my bone is healing properly? ›

Common Signs Your Broken Bone Is Healing
  1. *Routinely follow up with your healthcare provider during the healing process. ...
  2. Decreased Pain. ...
  3. Increased Range of Motion. ...
  4. Reduced Swelling. ...
  5. Less Bruising. ...
  6. *Routinely follow up with your healthcare provider during the healing process. ...
  7. Speak with an Orthopedic Specialist Today.

Do all bones heal in 6 weeks? ›

On average, a broken bone can take anywhere from six to eight weeks to heal before it can be used again. For young children, the healing process may happen more quickly. For older adults or those who have an underlying health condition, such as diabetes, healing can take longer.

What bone is the most painful to break? ›

The Femur is often put at the top of the most painful bones to break. Your Femur is the longest and strongest bone in your body, running from your hip to your knee. Given its importance, it's not surprising that breaking this bone is an incredibly painful experience, especially with the constant weight being put on it.

What slows down bone healing? ›

Smoking and high glucose levels interfere with bone healing. For all patients with fractured bones, immobilization is a critical part of treatment because any movement of bone fragments slows down the initial healing process.

Is hot water good for broken bones? ›

Blood is shunted towards the site, carrying inflammatory chemicals, which initiates healing in the area of the broken bone. It is in this stage that it is highly advised against applying heat to the affected area, as excessive swelling can cause increased pain and other complications.

What are five factors that affect bone healing? ›

Factors that influence fracture healing are both local and systemic; the former include particularly the degree of local trauma and bone loss, the type of bone affected, the degree of immobilization and local pathologic conditions; the latter include age, hormones, local stress and electric currents.

What is the most common type of bone healing? ›

Indirect (secondary) fracture healing is the most common form of fracture healing, and consists of both endochondral and intramembranous bone healing. It does not require anatomical reduction or rigidly stable conditions.

What is bone healing called? ›

Remodelling: The ongoing replacement of old bone tissue by new bone tissue is called remodelling. Bone formation, repair and remodelling is controlled and produced by four types of cell, namely osteoblasts, osteoclasts, osteocytes and bone lining cells.

Does a bone hurt while healing? ›

Acute pain is present when a bone fracture occurs. Sub-acute pain occurs during the healing process. Chronic pain happens after the fracture has healed.

How do you know if a bone has not healed? ›

“Patients who suspect their fracture has not healed after treatment or is not healing properly should look out for three things: pain at the site, deformity – the bone was straight and now it's bent – and impaired use or function – leg or ankle still cannot support weight.

Do bones move while healing? ›

Most broken bones are treated with a cast, splint, or brace. This keeps the broken bone from moving while it heals. Even broken bones that don't line up (called displaced) often will heal straight over time.

What is the longest bone to heal? ›

The femur — your thigh bone — is the largest and strongest bone in your body. When the femur breaks, it takes a long time to heal.

How healed is a bone after 2 weeks? ›

About 2 weeks after the break, cells called osteoblasts move in and get to work. They form new bone, adding minerals to the mix to make the bone hard and strong as it bridges the broken pieces. This stage is called the hard callus.

How often do your bones regrow? ›

The body's skeleton forms and grows to its adult size in a process called modeling. It then completely regenerates — or remodels — itself about every 10 years. Remodeling removes old pieces of bone and replaces them with new, fresh bone tissue.

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