title: Bone fractures in the long-term care of a patient in a vegetative state: a risk to conflicts.
abstract: OBJECTIVE
  This case report shows how recurrent bone fractures can increase the tension in the relationship between family and caregivers in the long-term care of a patient in a vegetative state (VS). The aim of this report is to prevent conflict situations elsewhere by informing the family in time about the risk of fractures in a situation of severe osteoporosis.
  
  
  RESULTS
  A second opinion and a density test of the bone contributed to the acceptance of the family of that risk in the daily nursing care, after all adjustments to prevent fractures and to adapt the environment were undertaken.
  
  
  CONCLUSIONS
  The registration of immobility and the risk of fractures in the problem list is recommended, particularly in the emotional context of the long-term care of a vegetative state. This should be part of the multidisciplinary care plan, in which regular evaluations and communication with family are essential.
authors.affiliation: Nursing Home Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. j.lavrijsen@vphg.umcn.nl
authors.forename: Jan
authors.initials: J
authors.lastname: Lavrijsen
authors.forename: Hans
authors.initials: H
authors.lastname: van den Bosch
authors.forename: Joost
authors.initials: J
authors.lastname: Vegter
mesh_terms: D000328:Adult; D034462:Dissent and Disputes; D050723:Fractures, Bone / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D010024:Osteoporosis / Q000150:complications*; D010346:Patient Care Management / Q000592:standards; D018458:Persistent Vegetative State / Q000150:complications*; D012008:Recurrence; D012017:Referral and Consultation; D016896:Treatment Outcome