DOI: https://doi.org/10.22263/2312-4156.2026.2.70
P.E. Vankovich, O.P. Kezlya, V.A. Chizhik
Treatment of closed diaphyseal fractures of the tibia in patients with mild and moderate cognitive impairments in the early postoperative period
Belarusian State Medical University, Minsk, Republic of Belarus
Vestnik VGMU. 2026;25(2):70-79.
Abstract.
Scientific novelty. The authors have proposed for the first time a comprehensive approach to the treatment of closed diaphyseal tibia fractures in patients with mild to moderate cognitive impairment in the early postoperative period.
Objectives. To evaluate the effectiveness of treating closed diaphyseal tibia fractures in patients with mild to moderate cognitive impairment in the early postoperative period.
Material and Methods. The results of treating closed diaphyseal tibia fractures in patients with mild to moderate cognitive impairment in the early postoperative period are presented in 110 patients using metabolic therapy. All patients were divided into two study groups. The comparison group consisted of 45 patients who received standard treatment in the early postoperative period. The study group included 65 patients who, in addition to conventional therapy, received a course of metabolic therapy, including hyperbaric oxygen therapy (HBOT) sessions and intravenous Cytoflavin infusions.
Results. Patients receiving complex metabolic therapy had a predominance of predementia cognitive impairment (65.5%), mild cognitive impairment was observed in 38.5%, moderate dementia was not detected, pain relief according to the Visual Analytical Scale (VAS) occurred on the third postoperative day, good long-term results according to the Luboschitz-Mattis-Schwartzberg scale were observed in 89.2% of cases, excellent results according to the Johner-Wruchs scale were found in 53.8% of patients, and good results in 30.8%. Treatment outcomes were analyzed for all 110 (100%) patients.
Conclusionы. An effective method for the comprehensive treatment of closed diaphyseal fractures of the tibia in patients with mild to moderate cognitive impairment in the early postoperative period has been developed.
Keywords: cognitive impairment, hyperbaric oxygen therapy, diaphyseal fractures, postoperative period.
Sources of funding. The study was performed as the program target – 3.57 State Scientific Research Programs “Translational medicine”, subprogram “Innovative technologies in clinical medicine” on the funded subject “Work out the stimulation method of the reparative regeneration in the fracture zone region by introducing metabolic therapy in treatment complex”.
References
1. Slobodin TN, Goreva AV. Cognitive reserve: causes of decline and protective mechanisms. Mezhdunarodnyi Nevrologicheskii Zhurnal. 2012;(3):161-165. (In Russ.).
2. Lysova EA, Zhernakova NI, Gorelik SG, Titareva LV, Orobtsova MV, Poltoratskiy AN. Cognitive asthma as an object of geriatric rehabilitation. Sovremennye Problemy Zdravookhraneniya i Meditsinskoi Statistiki. 2020;(3):540-551. (In Russ.). doi: http://dx.doi.org/10.24411/2312-2935-2020- 00093
3. Loi SM, Cations M, Velakoulis D. Young-onsetdementiadiagnosis, managementandcare: a narrativereview. The Medical Journal of Australia. 2023 Mar;218(4):182-189. doi: http://dx.doi.org/10.5694/mja2.51849
4. Yang Y, Zhao X, Gao L, Wang Y, Wang J. Incidence and associated factors of delirium after orthopedic surgery in elderly patients: a systematic review and meta-analysis. Aging Clinicaland Experimental Research. 2021 Jun;33(6):1493-1506. doi: http://dx.doi.org/10.1007/s40520-020-01674-1
5. Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Anesthesiology. 2018 Nov;129(5):872-879. doi: http://dx.doi.org/10.1097/ALN.0000000000002334
6. Neymark MI, Shmelev VV, Rakhmonov AA, Titova ZA. Postoperative etiology and pathogenesis of cognitive dysfunction (overview). Obshchaya Reanimatologiya. 2023;19(1):60-71. (In Russ.). doi: http://dx.doi.org/10.15360/1813-9779-2023-1-2202
7. Evered L, Scott DA, Silbert B, Maruff P. Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesthesia and Analgesia. 2011 May;112(5):1179-1185. doi: http://dx.doi.org/10.1213/ANE.0b013e318215217e
8. Zozulya MV, Lenkin AI, Kurapeev IS, Lebedinskiy KM. Postoperative cognitive disorders: pathogenesis, methods of prevention and treatment. Anesteziologiya i Peanimatologiya. 2019;(3):25-33. (In Russ.). doi: http://dx.doi.org/10.17116/anaesthesiology201903125
9. Belov MV, Belova KYu. The modern view of providing medical care for fractures of the proximal thigh section in the elderly and the elderly. Rossiiskii Zhurnal Geriatricheskoi Meditsiny. 2021;(2):186-195. (In Russ.). doi: http://dx.doi.org/10.37586/2686-8636-2-2021-176-185
10. Fischer H, Maleitzke T, Eder C, Ahmad S, Stöckle U, Braun KF. Management of proximal femur fractures in the elderly: current concepts and treatment options. European Journal of Medical Research. 2021 Aug;26(1):86. doi: http://dx.doi.org/10.1186/s40001-021-00556-0
11. Akimenko TI, Zhenilo VM, Zdiruk SV, Aleksandrovich YuS. Reduction in the frequency of postoperative cognitive disorders following uterine inhalation amputation by sevoflurane. Al'manakh Klinicheskoi Meditsiny. 2018;46(7):699-707. (In Russ.). doi: http://dx.doi.org/10.18786/2072-0505- 2018-46-7-699-707
12. Prokopenko SV, Mozheyko EYu, Zubritskaya EM, Bezdenezhnykh AF. Correction of cognitive disorders in patients with craniocerebral trauma. Consilium Medicum. 2017;19(2.1):64-69. (In Russ.).
13. Trukhanova I, Bulgakova S, Zakharova N, Pyshcheva L, Pischaskin S. The effect of aortocoronary bypass on cognitive dysfunction in elderly patients with brachyrectal arteries. Vrach. 2018;29(6):4-6. (In Russ.). doi: http://dx.doi.org/10.29296/25877305-2018-06-01
14. Kennedy GEM, Mohandas P, Anderson LA, Kennedy M, Shirley DSL. Improving identification of cognitive impairment in fragility fracture patients: impact of educational guidelines on current practice. Geriatric Orthopaedic Surgery & Rehabilitation. 2020 Jul:11:2151459320935095. doi: http://dx.doi.org/10.1177/2151459320935095
15. Jackson J, Kiehl A, Jutte J. Cognitive impairment after trauma and orthopedic injury: key issues, identification, and treatment. Techniques in Orthopaedics. 2016;31(4):222-227. doi: http://dx.doi.org/10.1097/BTO.0000000000000197
16. Krishtafor AA. Cognitive functions in the acute period and correction of their disturbances with the use of thiocetam. Meditsinskie Perspektivy. 2017;22(3):60-68. (In Russ.). doi: http://dx.doi.org/10.26641/2307-0404.2017.3.111927
17. Shadchneva, NA, Fedulichev PN. The course of the late postoperative period after surgical treatment of a fracture in the proximal femoral area in patients with cognitive impairments during the COVID-19 pandemic. Tavricheskii Mediko-biologicheskii Vestnik. 2021;24(3):41-48. (In Russ.). doi: http://dx.doi.org/10.37279/2070-8092-2021-24-3-41-48
18. Ermokhina NV, Kuzovlev AN, Polyakov PA, Akchulpanov RA, Smirnova AV, Laricheva EA, i dr. Early postoperative cognitive disorders in patients after trauma surgery: a prospective study. Anesteziologiya i Reanimatologiya. 2024;(1):14-22. (In Russ.). doi: http://dx.doi.org/10.17116/anaesthesiology202401114
19. Vankovich PE, Kezlya OP, Selitskiy AV, Yuraga TM. Evaluation of the effectiveness of complex conservative therapy in patients with closed tibiatric fractures. Zhurnal Grodnenskogo Gosudarstvennogo Meditsinskogo Universiteta. 2025;23(5):435-443. (In Russ.). doi: http://dx.doi.org/10.25298/2221-8785-2025-23-5-435-443
20. Yang Y, Wei H, Zhou X, Zhang F, Wang C. Hyperbaric oxygen promotes neural stem cell proliferation by activating vascular endothelial growth factor/extracellular signal-regulated kinase signaling after traumatic brain injury. Neuroreport. 2017 Dec;28(18):1232-1238. doi: http://dx.doi.org/10.1097/WNR.0000000000000901
21. Vankovich PE, Kezlya OP, Selitskiy AV. New approaches in the complex treatment of closed segmental and multitudinous diaphyseal bone fractures of the leg. Meditsinskii Zhurnal. 2023;(4):4-13. (In Russ.). doi: http://dx.doi.org/10.51922/1818-426X.2023.4.4
22. Vankovich PE. The effect of metabolic therapy on inflammatory toxicity syndrome and bone regeneration markers in patients with closed tibiatric fractures. Zhurnal Grodnenskogo Gosudarstvennogo Meditsinskogo Universiteta. 2025;23(3):233-238. (In Russ.). doi: http://dx.doi.org/10.25298/2221-8785-2025-23-3-233-238
23. Kuibyshev med in-t im DI Ul'yanova; Davydkin NF, sost. Use hyperbaric oxygenation to optimize the conditions of reactive osteogenesis: metod rekomendatsii po terapii. Moscow, RF; 1981. 11 р. (In Russ.).
24. Smirnov AV, Nesterova OB, Golubev RV. Amber acid and its application in medicine. Part I. Amber acid: metabolite and regulator of metabolism of the human organism. Nefrologiya. 2014;18(2):33-41. (In Russ.).
25. Smetkin AA, Kirov MYu. Venous satiation monitoring in anesthesiology and intensive care. Obshchaya Reanimatologiya. 2008;4(4):86-90. (In Russ.).
26. Skripko VD, Pasko AYa, Kovalenko AL, Zaplutanov VA. Justification of the use of cytophlavine in the complex treatment of patients with postoperative hyperplasia. Khirurgiya Zhurnal imeni NI Pirogova. 2016;(7):53-57. (In Russ.). doi: http://dx.doi.org/10.17116/hirurgia2016753-57
27. Suslina ZA, Tanashyan MM, Smirnova IN, Kashina EM, Fedorova TN, Fedin PA. The antioxidant and neurotrophic action of cytophlavine in chronic cerebrovascular diseases. Vestnik Sankt-peterburgskoi Gosudarstvennoi Meditsinskoi Akademii imeni II Mechnikova. 2002;3(3):110-114. (In Russ.).
28. Afanasyev VV, Lukyanova IYu; Med akad poslediplom obrazovaniya. Features of cytoflavin use in modern clinical practice: monografiya. Saint Petersburg, RF: Taktik-Studio; 2010. 79 р. (In Russ.).
29. Kardash OF, Shestakova LG, Krachak DI, Chernookiy OG, Zasetskiy AE, Ostrovskiy YuP. The effect of cytoflavin on cognitive recovery after heart surgery for AI. Zhurnal Nevrologii i Psikhiatrii imeni SS Korsakova. 2011;111(7):76-79. (In Russ.).
30. Madzhidova EN, Yusupaliev BK, Sharipov FR, Azimova NM, Mukhammadsolikh ShB. Efficacy of cytoflavin in patients at high risk for cerebrovascular disease. Klinicheskaya Meditsina. 2020;98(6):456-460. (In Russ.). doi: http://dx.doi.org/10.30629/0023-2149-2020-98-6-456-460
31. Kovalenko AL, Nagibovich OA, Vishnevskiy AYu, Belekhov GA, Gubaydullin RR, Popov DV, i dr. Use of a drug affecting the metabolism to prevent postoperative cognitive disorders. Obshchaya Reanimatologiya. 2022;18(2):12-21. (In Russ.). doi: http://dx.doi.org/10.15360/1813-9779-2022-2-12-21
32. Ilinskiy NS, Parfenov SA, Kharitonova TV, Parfenov YuA. The effects of cytoflavin on cognitive recovery in elderly people with alcoholism. Zhurnal Nevrologii i Psikhiatrii imeni SS Korsakova. 2016;116(11 vyp 2):49-53. (In Russ.). doi: http://dx.doi.org/10.17116/jnevro201611611249-53
33. Galkin SA, Bokhan NA. Impaired cognitive decision-making mechanisms related to compensation in alcohol addiction. Zhurnal Nevrologii i Psikhiatrii imeni SS Korsakova. 2023;123(4):98-102. (In Russ.). doi: http://dx.doi.org/10.17116/jnevro202312304198
34. Folstein MF, Folstein SE, McHugh PR. «Mini-mental state». A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research. 1975 Nov;12(3):189-198. doi: http://dx.doi.org/10.1016/0022-3956(75)90026-6
Submitted 10.02.2026
Accepted 14.04.2026
Information about authors:
P.E. Vankovich – senior lecturer of the Chair of Traumatology and Orthopedics with the course of Advanced Training & Retraining, Belarusian State Medical University, https://orcid.org/0009-0000-8833-5865, e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра.;
O.P. Kezlya – Doctor of Medical Sciences, professor of the Chair of Traumatology and Orthopedics with the course of Advanced Training & Retraining, Belarusian State Medical University;
V.A. Chizhik – Candidate of Medical Sciences, senior lecturer of the Chair of Neurology and Neurosurgery of Institute for Advanced Training & Retraining of health workers, Belarusian State Medical University, https://orcid.org/0000-0002-8204-3965
