Diagrams for clavicle and scapular fracture

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I now have all the key diagrams needed. Here is the complete compiled answer:

Clavicle Fractures - Diagrams & Classification

1. Distal Clavicle Fracture (Neer/Rockwood Classification)

The image below shows the two key patterns of distal clavicle fractures - Type I (ligaments intact, fragments apposed) vs. Type II (ligament rupture with wide displacement):

$Distal clavicle fracture types - Neer I vs II$

Fig. 11.1 - When the distal end of the clavicle is fractured, the ligaments may either (A) remain intact and maintain apposition of the fracture fragments (Type I) or (B) rupture, allowing wide displacement of the fragments (Type II). Source: Miller's Review of Orthopaedics 9th Ed., p.900

Neer Classification (Distal Clavicle)

Type	Description
Type I	Fracture distal to CC ligaments; ligaments intact; minimal displacement
Type IIA	Both conoid and trapezoid attached to distal fragment; medial fragment displaced superiorly
Type IIB	Conoid detached from medial fragment (only trapezoid on distal fragment); unstable
Type III	Intra-articular extension into AC joint

2. Robinson Classification (Full Clavicle)

This is based on a database of >1,000 patients and includes fracture displacement, comminution, and intra-articular extension - making it the most clinically useful classification:

$Robinson classification scheme of clavicle fractures$

Figure 34-13. Robinson classification scheme of clavicle fractures. Source: Rockwood and Green's Fractures in Adults 10th Ed. 2025, p.1200

Robinson Classification Summary

Type	Location	Sub-types
Type 1	Medial third (Allman Group III)	1A = undisplaced (extra/intra-articular); 1B = displaced
Type 2	Middle third / shaft (Allman Group I)	2A = cortical alignment (undisplaced/angulated); 2B = displaced (simple or comminuted)
Type 3	Lateral third (Allman Group II)	3A = extra-articular undisplaced; 3B = extra-articular displaced (Neer II) or intra-articular

Key clinical note: Middle-third fractures account for ~80%, lateral for ~15%, and medial for ~5% of all clavicle fractures. Risk of nonunion increases significantly with >100% displacement of mid-shaft fractures.

3. Medial Clavicle Fracture (Radiograph + CT)

Medial clavicle fractures are difficult to see on plain X-ray due to bony overlap. CT is needed to assess posterior displacement and mediastinal involvement:

$Medial clavicle fracture - X-ray and CT$

Figure 34-12. Medial clavicle fracture in a 32-year-old female. A: AP radiograph shows subtle asymmetry. B/C: CT scans demonstrate posterior shaft displacement impinging on mediastinal structures (large arrow = shaft, small arrow = residual medial fragment). D: Plate fixation with sternal extension. Source: Rockwood and Green's Fractures in Adults 10th Ed. 2025, p.1199

Scapular Fractures - Diagrams & Classification

4. Ada-Miller Classification of Scapular Fractures

The most widely used clinical classification based on anatomical location:

$Ada-Miller classification of scapular fractures$

Figure 33-8. Ada-Miller classification of scapular fractures. Source: Rockwood and Green's Fractures in Adults 10th Ed. 2025, p.1158

Ada-Miller Classification

Type	Region	Sub-types
I	Processes	IA = Acromion; IB = Scapular spine; IC = Coracoid process
II	Neck	IIA = Surgical neck; IIB = Trans-spinous neck; IIC = Neck inferior to spine
III	Glenoid fossa (intra-articular)	-
IV	Scapular body	-

5. OTA/AO Classification (Glenoid Fossa - Multifragmentary)

The OTA/AO system (updated 2018) designates the scapula as segment 14, divided into:

14A - Process fractures (A1 = coracoid, A2 = acromion, A3 = spine)
14B - Body fractures (B1 = exits ≤2 points, B2 = exits ≥3 points)
14F - Glenoid fossa fractures (F0 = extra-articular neck; F1 = simple articular; F2 = multifragmentary)

The diagram below shows a multifragmentary glenoid fossa fracture (OTA group 14F2.2 - central fracture-dislocation):

$OTA/AO multifragmentary glenoid fossa fracture - 14F2.2$

Figure 33-10. OTA/AO classification for central fracture-dislocations (group 14F2.2): multifragmentary glenoid fossa with ≥3 articular fragments. Source: Rockwood and Green's Fractures in Adults 10th Ed. 2025, p.1161

Quick Reference Summary

Fracture	Key Classification	Most Common Type
Clavicle	Robinson (clinical); Allman (anatomical thirds)	Middle third (80%)
Distal clavicle	Neer/Rockwood	Type II (unstable - CC ligament disruption)
Scapula	Ada-Miller	Body fractures (~50%); Glenoid (~25%)
Glenoid	OTA/AO 14F; Ideberg	Anterior rim (with anterior shoulder dislocation)

Sources: Miller's Review of Orthopaedics 9th Ed., p.900 | Rockwood and Green's Fractures in Adults 10th Ed. 2025, pp.1158-1201

+6 more

Give diagrams for this fractures.

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Here are the diagrams for all the fractures listed in your table:

Upper Limb Fractures - Diagrams

1. Proximal Humerus Fracture (Neer Classification)

The Neer system defines a "part" as displacement >1 cm or angulation >45°. The four parts are: (1) articular head, (2) lesser tuberosity, (3) greater tuberosity, and (4) humeral shaft.

$Proximal humerus fracture - Neer 4-part anatomy with muscle vectors$

FIG. 11.3 - Proximal humeral fracture. Four parts: 1 = head, 2 = lesser tuberosity, 3 = greater tuberosity, 4 = humeral shaft. Arrows show muscle contraction vectors. Source: Miller's Review of Orthopaedics 9th Ed., p.901

Neer Type	Description
1-part	Nondisplaced/minimally displaced (any number of fracture lines)
2-part	One segment displaced >1 cm or angled >45°
3-part	Greater or lesser tuberosity + articular surface displaced
4-part	Shaft, articular surface, and both tuberosities all displaced - highest AVN risk

2. Distal Humerus Fracture - Condyle Types (Milch Classification)

$Humeral condyle fractures - Milch Type I and II (lateral and medial)$

FIG. 11.4 - Humeral condyle fractures. Lateral and medial condyle Milch Type I and II fracture lines. Source: Miller's Review of Orthopaedics 9th Ed., p.903

Supracondylar: Most common pediatric elbow fracture; extension type (95%) vs. flexion type. Main complication = Volkmann's ischemic contracture (missed compartment syndrome)
Milch Type I: Lateral trochlear ridge intact
Milch Type II: Fracture through lateral trochlear ridge (unstable - requires ORIF)

3. Radial Head Fracture (Mason Classification)

$Mason Classification Type I - nondisplaced radial head fracture$

Type I - Nondisplaced radial head fracture (marginal)

$Mason Classification Type III - comminuted radial head fracture$

Type III - Comminuted fracture involving the entire head. Source: Modified Mason Classification, Miller's Review of Orthopaedics 9th Ed., p.904

Mason Type	Description	Treatment
Type I	Nondisplaced marginal fracture	Sling, early ROM within 7 days
Type II	Partial articular with displacement	ORIF if block to motion exists
Type III	Comminuted, entire head involved	Radial head replacement (≥3 fragments)
Type IV	Any fracture + elbow dislocation	ORIF or replacement mandatory

4. Monteggia Fracture-Dislocation (Bado Classification)

X-ray showing Monteggia fracture with comminuted proximal ulna fracture and anterior radial head dislocation:

$Monteggia fracture-dislocation radiograph$

Figure 270-15. Monteggia fracture-dislocation. The apex of the comminuted ulna fracture points in the direction of radial head dislocation. Source: Tintinalli's Emergency Medicine

Bado Type	Ulna Fracture	Radial Head	Frequency
Type I	Apex anterior angulation	Anterior dislocation	Most common in children (60%)
Type II	Apex posterior angulation	Posterior dislocation	Most common in adults (up to 80%)
Type III	Metaphyseal fracture	Lateral dislocation	Almost exclusively children
Type IV	Proximal shaft fracture + radius fracture	Anterior dislocation	Rare, adults only

Key rule: Apex of ulna fracture points toward direction of radial head dislocation.

5. Galeazzi Fracture-Dislocation

Radial shaft fracture + distal radioulnar joint (DRUJ) dislocation:

$Galeazzi fracture-dislocation - AP and lateral radiograph$

Figure 270-16. Galeazzi fracture-dislocation - radial shaft fracture with DRUJ disruption. Source: Tintinalli's Emergency Medicine

Also called "fracture of necessity" because ORIF is mandatory
Reverse of Monteggia: radius fractures, ulna dislocates at DRUJ
Type I (within 7.5 cm of articular surface): Higher rate of DRUJ instability

6. Distal Radius Fracture (OTA/AO Classification)

The most comprehensive classification - 27 possible patterns across 3 main groups:

OTA/AO Classification of Distal Radius Fractures - all types A, B, C

Figure 43-4. OTA/AO classification of distal radius and ulna fractures. Source: Rockwood and Green's Fractures in Adults 10th Ed. 2025

OTA Group	Type	Classic Eponym
A	Extra-articular	Colles' (dorsal angulation), Smith's (volar angulation)
B	Partial articular	Barton's (shear fracture), Chauffeur's (radial styloid)
C	Complete articular	Die-punch, comminuted intra-articular

7. Pediatric Distal Radius / Forearm Fractures

Dorsally angulated metaphyseal buckle/torus fracture - plain radiographs (AP and lateral):

$Pediatric distal radius fracture AP and lateral$

Figure 32.28(a) - 10-year-old child with dorsally angulated metaphyseal radius fracture (buckle/torus type) and undisplaced ulna fracture. Source: Bailey & Love's Short Practice of Surgery 28th Ed.

Post-reduction and cast application at 8 weeks (united with residual 11° dorsal angulation):

$Pediatric distal radius fracture - 8 weeks post-reduction$

Figure 32.28(b/c) - Post-reduction radiograph, and then complete remodelling 2 years later at age 12. Source: Bailey & Love's Short Practice of Surgery 28th Ed.

Pediatric Fracture Type	Description
Buckle (Torus)	Cortex buckles/bulges without complete cortical break; seen at metaphysis; most common in distal radius/ulna
Greenstick	Incomplete fracture - one cortex breaks, other bends; unique to children due to bone flexibility

Quick Reference Summary

Fracture	Classification System	Key Teaching Point
Proximal humerus	Neer (4 parts)	AVN risk highest in 4-part fractures
Humeral shaft	OTA/AO (transverse, oblique, comminuted)	Radial nerve palsy in 5-10%; observe 3-4 months
Distal humerus	Milch (condyle); supracondylar Gartland	Volkmann's contracture feared complication
Radial head	Mason (I-IV)	Apex of ulna fracture = direction of dislocation in Monteggia
Monteggia	Bado (I-IV)	Type II most common in adults
Galeazzi	Distance from articular surface	Always needs ORIF
Distal radius	OTA/AO A/B/C	Most common fracture in adults
Scaphoid	Waist, proximal pole, distal pole	Proximal pole = high AVN risk, poorest healing
Pediatric	Buckle, greenstick, Salter-Harris	Remodelling potential is high in children

Sources: Miller's Review of Orthopaedics 9th Ed. | Rockwood and Green's Fractures in Adults 10th Ed. 2025 | Tintinalli's Emergency Medicine | Bailey & Love's Short Practice of Surgery 28th Ed.

Create a study guide PDF comparing fracture classifications with its diagrams

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mkdir -p /home/daytona/workspace/fracture-study-guide && ls /home/daytona/worksp…

Writing File

~/fracture-study-guide/build_pdf.py

#!/usr/bin/env python3
"""
Fracture Classifications Study Guide PDF Generator
Uses ReportLab for rich PDF layout with images + tables
"""

import os
import requests
from io import BytesIO
from PIL import Image as PILImage

from reportlab.lib.pagesizes import A4
from reportlab.lib.units import cm, mm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.colors import HexColor, white, black, Color
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    Image, KeepTogether, HRFlowable, PageBreak
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.lib import colors

# ── Output path ─────────────────────────────────────────────────────────────
OUTPUT = "/home/daytona/workspace/fracture-study-guide/Fracture_Classifications_Study_Guide.pdf"
IMG_DIR = "/home/daytona/workspace/fracture-study-guide/images"
os.makedirs(IMG_DIR, exist_ok=True)

# ── Colour palette ───────────────────────────────────────────────────────────
C_NAVY      = HexColor("#1a2e4a")
C_TEAL      = HexColor("#0d7377")
C_LIGHT     = HexColor("#e8f4f8")
C_ACCENT    = HexColor("#f0a500")
C_HEADER_BG = HexColor("#1a2e4a")
C_ROW_ODD   = HexColor("#f5fafd")
C_ROW_EVEN  = HexColor("#ddeef5")
C_RED_LIGHT = HexColor("#fdf0f0")

# ── Image registry ───────────────────────────────────────────────────────────
IMAGES = {
    "neer_4parts":    "https://cdn.orris.care/cdss_images/6c6ffc06744c9b10628ff061059a5cb7e8b1aa7b6d5d5fa3ea12b9ebbf624ebe.png",
    "robinson_clav":  "https://cdn.orris.care/cdss_images/09d9b1fb1496328f60af806119e6e2ecf611f76586a69b8fe9ea99563326dcf2.png",
    "neer_distal_clav": "https://cdn.orris.care/cdss_images/1ee21158a808d73c0094df5ea4111845ce966f6b0442920dcc37973f6b69fc9a.png",
    "ada_miller_scap": "https://cdn.orris.care/cdss_images/b39f5d547ad1bd63f4126cd09b369a01139d06ae04c56c4243dd09520e36b517.png",
    "condyle_milch":  "https://cdn.orris.care/cdss_images/c9f0b92399e18d6af7d7c89fe02b4268dc830910ec4f96173bfb5dcf81d1fcf5.png",
    "mason_I":        "https://cdn.orris.care/cdss_images/568fa1185bc4d2bf1e94c34db387d4f6cb9fc8f8b22b1667968a71a89e23eb78.png",
    "mason_III":      "https://cdn.orris.care/cdss_images/88d4e9cfd027256936788ebc05a82af58a421dca6beb0d957a7cd87e38fa446f.png",
    "monteggia_xr":   "https://cdn.orris.care/cdss_images/2402ebcd7f5d9d0fdad83de75d41085fe2e1c5d5d4b7c43b85509b8fb7f3a43d.png",
    "galeazzi_xr":    "https://cdn.orris.care/cdss_images/d641870085d39390c1b12dfae9100f236c8161ad7159e0fd3648d4bb30826eff.png",
    "distal_radius":  "https://cdn.orris.care/cdss_images/e65d21de0fc813faa451e0ce0439fd70476a4b041ff4460b9f713464efe1300d.png",
    "ped_radius_a":   "https://cdn.orris.care/cdss_images/9a247a27480aef8b4ddb7013db1ea676a17d417746c21213109eda2f75fec0aa.png",
    "ped_radius_b":   "https://cdn.orris.care/cdss_images/7ab31f3162f6b47f64cdaaff731425e72adf34f2c8b769dad98b20579d06c932.png",
    "medial_clav_ct": "https://cdn.orris.care/cdss_images/3e8c4672bc3c4bd91388eb71d67a9d835c1248ed0402853566767081693071db.png",
    "glenoid_fract":  "https://cdn.orris.care/cdss_images/a077a86a347fc98d0bc6c8585662a14c2145b94554a5020d4fb6ec8b9015d102.png",
}

def download_images():
    paths = {}
    for name, url in IMAGES.items():
        dest = os.path.join(IMG_DIR, f"{name}.png")
        if not os.path.exists(dest):
            try:
                r = requests.get(url, timeout=20)
                with open(dest, "wb") as f:
                    f.write(r.content)
                print(f"  Downloaded: {name}")
            except Exception as e:
                print(f"  FAILED: {name} — {e}")
                dest = None
        paths[name] = dest
    return paths

def img(paths, key, width=8*cm, max_height=None):
    p = paths.get(key)
    if not p or not os.path.exists(p):
        return Spacer(1, 0.5*cm)
    try:
        im = PILImage.open(p)
        w, h = im.size
        aspect = h / w
        height = width * aspect
        if max_height and height > max_height:
            height = max_height
            width  = height / aspect
        return Image(p, width=width, height=height)
    except Exception as e:
        print(f"  Image error {key}: {e}")
        return Spacer(1, 0.5*cm)

# ── Styles ───────────────────────────────────────────────────────────────────
def make_styles():
    base = getSampleStyleSheet()

    styles = {}

    styles["cover_title"] = ParagraphStyle(
        "cover_title", fontName="Helvetica-Bold", fontSize=28,
        textColor=white, alignment=TA_CENTER, leading=34, spaceAfter=10)

    styles["cover_sub"] = ParagraphStyle(
        "cover_sub", fontName="Helvetica", fontSize=14,
        textColor=HexColor("#cce8f0"), alignment=TA_CENTER, leading=18)

    styles["section"] = ParagraphStyle(
        "section", fontName="Helvetica-Bold", fontSize=15,
        textColor=white, alignment=TA_LEFT, leading=20,
        leftIndent=8, spaceBefore=4, spaceAfter=4)

    styles["subsection"] = ParagraphStyle(
        "subsection", fontName="Helvetica-Bold", fontSize=12,
        textColor=C_NAVY, leading=16, spaceBefore=8, spaceAfter=4)

    styles["body"] = ParagraphStyle(
        "body", fontName="Helvetica", fontSize=9.5,
        textColor=HexColor("#222222"), leading=14,
        spaceBefore=3, spaceAfter=3)

    styles["caption"] = ParagraphStyle(
        "caption", fontName="Helvetica-Oblique", fontSize=8,
        textColor=HexColor("#555555"), alignment=TA_CENTER, leading=11,
        spaceBefore=2, spaceAfter=6)

    styles["key_point"] = ParagraphStyle(
        "key_point", fontName="Helvetica-Bold", fontSize=9,
        textColor=C_NAVY, leading=13, leftIndent=10,
        bulletIndent=0, spaceBefore=2, spaceAfter=2)

    styles["toc_entry"] = ParagraphStyle(
        "toc_entry", fontName="Helvetica", fontSize=10,
        textColor=C_NAVY, leading=16, leftIndent=16)

    return styles

# ── Table helper ─────────────────────────────────────────────────────────────
def styled_table(data, col_widths, header_bg=C_HEADER_BG):
    style = TableStyle([
        ("BACKGROUND",    (0, 0), (-1, 0),  header_bg),
        ("TEXTCOLOR",     (0, 0), (-1, 0),  white),
        ("FONTNAME",      (0, 0), (-1, 0),  "Helvetica-Bold"),
        ("FONTSIZE",      (0, 0), (-1, 0),  9),
        ("ALIGN",         (0, 0), (-1, 0),  "CENTER"),
        ("ROWBACKGROUNDS",(0, 1), (-1, -1), [C_ROW_ODD, C_ROW_EVEN]),
        ("FONTNAME",      (0, 1), (-1, -1), "Helvetica"),
        ("FONTSIZE",      (0, 1), (-1, -1), 8.5),
        ("ALIGN",         (0, 1), (-1, -1), "LEFT"),
        ("VALIGN",        (0, 0), (-1, -1), "MIDDLE"),
        ("GRID",          (0, 0), (-1, -1), 0.4, HexColor("#b0ccd8")),
        ("TOPPADDING",    (0, 0), (-1, -1), 4),
        ("BOTTOMPADDING", (0, 0), (-1, -1), 4),
        ("LEFTPADDING",   (0, 0), (-1, -1), 6),
        ("RIGHTPADDING",  (0, 0), (-1, -1), 6),
        ("ROUNDEDCORNERS",[2]),
    ])
    t = Table(data, colWidths=col_widths, repeatRows=1)
    t.setStyle(style)
    return t

def section_banner(text, styles):
    banner_data = [[Paragraph(text, styles["section"])]]
    t = Table(banner_data, colWidths=[17.2*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",   (0,0), (-1,-1), C_NAVY),
        ("LEFTPADDING",  (0,0), (-1,-1), 10),
        ("RIGHTPADDING", (0,0), (-1,-1), 10),
        ("TOPPADDING",   (0,0), (-1,-1), 6),
        ("BOTTOMPADDING",(0,0), (-1,-1), 6),
        ("ROUNDEDCORNERS",[3]),
    ]))
    return t

def accent_box(text, styles, bg=C_LIGHT):
    data = [[Paragraph(text, styles["body"])]]
    t = Table(data, colWidths=[17.2*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0),(-1,-1), bg),
        ("LEFTPADDING",   (0,0),(-1,-1), 10),
        ("RIGHTPADDING",  (0,0),(-1,-1), 10),
        ("TOPPADDING",    (0,0),(-1,-1), 6),
        ("BOTTOMPADDING", (0,0),(-1,-1), 6),
        ("BOX",           (0,0),(-1,-1), 1, C_TEAL),
        ("ROUNDEDCORNERS",[3]),
    ]))
    return t

# ── Cover page ───────────────────────────────────────────────────────────────
def build_cover(story, styles):
    # Blue background band
    bg_data = [[
        Paragraph("FRACTURE CLASSIFICATIONS", styles["cover_title"]),
    ]]
    t = Table(bg_data, colWidths=[17.2*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0),(-1,-1), C_NAVY),
        ("TOPPADDING",    (0,0),(-1,-1), 40),
        ("BOTTOMPADDING", (0,0),(-1,-1), 10),
        ("LEFTPADDING",   (0,0),(-1,-1), 10),
        ("RIGHTPADDING",  (0,0),(-1,-1), 10),
    ]))
    story.append(t)

    sub_data = [[Paragraph("A Comparative Study Guide with Diagrams", styles["cover_sub"])]]
    t2 = Table(sub_data, colWidths=[17.2*cm])
    t2.setStyle(TableStyle([
        ("BACKGROUND",    (0,0),(-1,-1), C_TEAL),
        ("TOPPADDING",    (0,0),(-1,-1), 14),
        ("BOTTOMPADDING", (0,0),(-1,-1), 14),
        ("LEFTPADDING",   (0,0),(-1,-1), 10),
        ("RIGHTPADDING",  (0,0),(-1,-1), 10),
    ]))
    story.append(t2)
    story.append(Spacer(1, 0.6*cm))

    # TOC
    toc_items = [
        "1.  Shoulder Girdle Fractures",
        "       • Clavicle Fractures — Robinson, Neer, OTA/AO",
        "       • Scapular Fractures — Ada-Miller, OTA/AO",
        "2.  Proximal Humerus Fractures — Neer Classification",
        "3.  Distal Humerus Fractures — Milch, Supracondylar Gartland",
        "4.  Radial Head Fractures — Mason Classification",
        "5.  Forearm Fractures",
        "       • Monteggia — Bado Classification",
        "       • Galeazzi Fracture-Dislocation",
        "       • Both-Bone / Ulnar Nightstick",
        "6.  Distal Radius Fractures — OTA/AO, Named Eponyms",
        "7.  Scaphoid Fractures",
        "8.  Pediatric Fractures — Buckle, Greenstick, Salter-Harris",
        "9.  Quick Reference Comparison Table",
    ]
    toc_entries = []
    for item in toc_items:
        toc_entries.append([Paragraph(item, styles["toc_entry"])])

    toc_table = Table(toc_entries, colWidths=[17.2*cm])
    toc_table.setStyle(TableStyle([
        ("BACKGROUND",    (0,0),(-1,-1), C_LIGHT),
        ("TOPPADDING",    (0,0),(-1,-1), 3),
        ("BOTTOMPADDING", (0,0),(-1,-1), 3),
        ("LEFTPADDING",   (0,0),(-1,-1), 16),
        ("RIGHTPADDING",  (0,0),(-1,-1), 10),
        ("BOX",           (0,0),(-1,-1), 1.2, C_TEAL),
    ]))
    story.append(toc_table)
    story.append(Spacer(1, 0.6*cm))

    src_text = ("<b>Sources:</b> Miller's Review of Orthopaedics 9th Ed. | "
                "Rockwood & Green's Fractures in Adults 10th Ed. 2025 | "
                "Tintinalli's Emergency Medicine | Bailey & Love's Short Practice of Surgery 28th Ed. | "
                "Campbell's Operative Orthopaedics 15th Ed. 2026")
    story.append(accent_box(src_text, styles))
    story.append(PageBreak())

# ── Section 1: Shoulder Girdle ───────────────────────────────────────────────
def build_shoulder(story, styles, paths):
    story.append(section_banner("SECTION 1 — SHOULDER GIRDLE FRACTURES", styles))
    story.append(Spacer(1, 0.3*cm))

    # --- Clavicle ---
    story.append(Paragraph("A. Clavicle Fractures", styles["subsection"]))
    story.append(Paragraph(
        "Clavicle fractures account for ~3% of all fractures and ~35% of shoulder girdle injuries. "
        "The most common site is the middle third (80%), followed by lateral (15%) and medial (5%).",
        styles["body"]))
    story.append(Spacer(1,0.2*cm))

    # Robinson classification diagram
    story.append(Paragraph("Robinson Classification (Edinburgh) — Full Clavicle", styles["key_point"]))
    story.append(img(paths, "robinson_clav", width=14*cm))
    story.append(Paragraph(
        "Figure 1. Robinson Classification of clavicle fractures. Cross-references Allman (Group I-III) "
        "and Craig classifications. Source: Rockwood & Green's Fractures in Adults 10th Ed., p.1200",
        styles["caption"]))

    robinson_data = [
        ["Robinson Type", "Location", "Sub-types", "Allman Equivalent"],
        ["Type 1", "Medial third", "1A = undisplaced; 1B = displaced", "Group III"],
        ["Type 2", "Middle third (shaft)", "2A = cortical alignment; 2B = displaced (simple/comminuted)", "Group I"],
        ["Type 3", "Lateral third", "3A = extra-articular; 3B = displaced / intra-articular", "Group II"],
    ]
    story.append(styled_table(robinson_data, [3.2*cm, 3.2*cm, 7.5*cm, 3.3*cm]))
    story.append(Spacer(1, 0.4*cm))

    # Neer distal clavicle
    story.append(Paragraph("Neer / Rockwood Classification — Distal Clavicle Fractures", styles["key_point"]))
    img_row = [[
        img(paths, "neer_distal_clav", width=8*cm),
        Table([[
            Paragraph("<b>Type I</b> — Distal to CC ligaments; ligaments intact; minimal displacement.<br/><br/>"
                      "<b>Type IIA</b> — Both conoid and trapezoid attached to distal fragment; medial fragment displaced superiorly.<br/><br/>"
                      "<b>Type IIB</b> — Conoid detached from medial fragment; most unstable.<br/><br/>"
                      "<b>Type III</b> — Intra-articular extension into AC joint.<br/><br/>"
                      "<font color='#c00000'><b>Clinical note:</b></font> Type II = high nonunion risk → ORIF usually required.",
                      styles["body"])
        ]], colWidths=[8.5*cm],
           style=[("VALIGN",(0,0),(-1,-1),"TOP"),("LEFTPADDING",(0,0),(-1,-1),8)])
    ]]
    story.append(Table(img_row, colWidths=[8.5*cm, 8.7*cm]))
    story.append(Paragraph(
        "Figure 2. Distal clavicle fracture: (A) Type I — ligaments intact; (B) Type II — ligament rupture with wide displacement. "
        "Source: Miller's Review of Orthopaedics 9th Ed., p.900",
        styles["caption"]))

    # Medial clavicle CT
    story.append(Spacer(1, 0.2*cm))
    story.append(Paragraph("Medial Clavicle Fracture — Imaging", styles["key_point"]))
    story.append(img(paths, "medial_clav_ct", width=14*cm, max_height=7*cm))
    story.append(Paragraph(
        "Figure 3. Medial clavicle fracture. A: AP radiograph shows subtle asymmetry. "
        "B/C: CT demonstrates posterior shaft displacement impinging mediastinal structures (arrows). "
        "D: Post-ORIF with plate extending onto sternum. Source: Rockwood & Green's 10th Ed., p.1199",
        styles["caption"]))
    story.append(Spacer(1, 0.3*cm))

    accent_txt = ("<b>Key clinical points — Clavicle fractures:</b><br/>"
                  "• Nonunion risk increases with >100% displacement of mid-shaft fractures<br/>"
                  "• Absolute operative indications: open fracture, neurovascular compromise<br/>"
                  "• Relative indications: shortening >2 cm, significant displacement, nonunion<br/>"
                  "• Medial fractures require CT to assess posterior displacement and mediastinal compromise")
    story.append(accent_box(accent_txt, styles, bg=HexColor("#fff8e6")))
    story.append(Spacer(1, 0.4*cm))

    # --- Scapula ---
    story.append(HRFlowable(width="100%", thickness=1, color=C_TEAL))
    story.append(Spacer(1, 0.2*cm))
    story.append(Paragraph("B. Scapular Fractures", styles["subsection"]))
    story.append(Paragraph(
        "Scapular fractures represent <1% of all fractures. Due to the force required, ~80–90% have associated injuries "
        "(rib fractures, pneumothorax, brachial plexus injury). Management is usually nonoperative.",
        styles["body"]))

    story.append(Paragraph("Ada-Miller Classification (Most Widely Used)", styles["key_point"]))
    img_row2 = [[
        img(paths, "ada_miller_scap", width=8*cm),
        Table([[
            Paragraph("<b>Type I — Process fractures</b><br/>"
                      "IA = Acromion<br/>IB = Scapular spine<br/>IC = Coracoid process<br/><br/>"
                      "<b>Type II — Neck fractures</b><br/>"
                      "IIA = Surgical neck<br/>IIB = Trans-spinous neck<br/>IIC = Neck inferior to spine<br/><br/>"
                      "<b>Type III — Glenoid fossa</b> (intra-articular, 25%)<br/><br/>"
                      "<b>Type IV — Scapular body</b> (~50% of all scapular fractures)",
                      styles["body"])
        ]], colWidths=[8.5*cm],
           style=[("VALIGN",(0,0),(-1,-1),"TOP"),("LEFTPADDING",(0,0),(-1,-1),8)])
    ]]
    story.append(Table(img_row2, colWidths=[8.5*cm, 8.7*cm]))
    story.append(Paragraph(
        "Figure 4. Ada-Miller classification of scapular fractures. "
        "Source: Rockwood & Green's Fractures in Adults 10th Ed., p.1158",
        styles["caption"]))

    story.append(Spacer(1, 0.2*cm))
    story.append(Paragraph("OTA/AO Glenoid Fossa — Multifragmentary (14F2.2)", styles["key_point"]))
    story.append(img(paths, "glenoid_fract", width=7*cm))
    story.append(Paragraph(
        "Figure 5. OTA/AO group 14F2.2 — central fracture-dislocation of the glenoid fossa "
        "(multifragmentary, ≥3 articular fragments). Source: Rockwood & Green's 10th Ed., p.1161",
        styles["caption"]))

    ada_data = [
        ["OTA/AO Segment 14", "Sub-type", "Description"],
        ["14A — Processes",    "A1, A2, A3", "Coracoid / Acromion / Scapular spine"],
        ["14B — Body",         "B1, B2",     "B1: exits ≤2 points; B2: exits ≥3 points"],
        ["14F — Glenoid fossa","F0, F1, F2", "F0: neck; F1: simple articular; F2: multifragmentary"],
    ]
    story.append(styled_table(ada_data, [5.2*cm, 3.5*cm, 8.5*cm]))
    story.append(PageBreak())

# ── Section 2: Proximal Humerus ──────────────────────────────────────────────
def build_prox_humerus(story, styles, paths):
    story.append(section_banner("SECTION 2 — PROXIMAL HUMERUS FRACTURES", styles))
    story.append(Spacer(1, 0.3*cm))
    story.append(Paragraph(
        "Proximal humerus fractures account for ~5% of all fractures, commonly in elderly osteoporotic patients. "
        "The Neer system is based on displacement of four anatomical segments. A 'part' is defined as "
        "displacement >1 cm or angulation >45°.",
        styles["body"]))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("Neer Classification — Four Anatomical Parts", styles["key_point"]))
    story.append(img(paths, "neer_4parts", width=11*cm))
    story.append(Paragraph(
        "Figure 6. Proximal humeral fracture — Neer four parts: 1 = articular head, 2 = lesser tuberosity, "
        "3 = greater tuberosity, 4 = humeral shaft. Arrows indicate muscle contraction vectors. "
        "Source: Miller's Review of Orthopaedics 9th Ed., p.901",
        styles["caption"]))

    neer_data = [
        ["Neer Type", "Parts Displaced", "Description", "Treatment"],
        ["1-Part",    "None",            "Any # of fracture lines; no significant displacement",     "Sling, early ROM"],
        ["2-Part",    "1",               "Surgical neck (most common); greater/lesser tuberosity",   "ORIF or CRPP"],
        ["3-Part",    "2",               "Neck + greater OR lesser tuberosity displaced",            "ORIF; consider RSA in elderly"],
        ["4-Part",    "3",               "Head + shaft + both tuberosities all displaced",           "RSA; ORIF only in young pts"],
        ["Head-split","—",               "Fracture through the articular surface",                   "Hemiarthroplasty / RSA"],
    ]
    story.append(styled_table(neer_data, [2.5*cm, 2.5*cm, 7.5*cm, 4.7*cm]))
    story.append(Spacer(1, 0.3*cm))

    accent_txt = ("<b>AVN Risk Factors (Hertel Criteria):</b> medial periosteal hinge disruption | "
                  "medial metadiaphyseal extension <8 mm (calcar <8 mm) | fracture complexity | "
                  "displacement >10 mm | angulation >45°<br/>"
                  "<b>Most common complication:</b> screw cutout | "
                  "<b>Most common nonunion site:</b> two-part surgical neck fracture")
    story.append(accent_box(accent_txt, styles, bg=C_RED_LIGHT))
    story.append(PageBreak())

# ── Section 3: Distal Humerus ────────────────────────────────────────────────
def build_distal_humerus(story, styles, paths):
    story.append(section_banner("SECTION 3 — DISTAL HUMERUS FRACTURES", styles))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("A. Condyle Fractures — Milch Classification", styles["subsection"]))
    story.append(img(paths, "condyle_milch", width=12*cm))
    story.append(Paragraph(
        "Figure 7. Humeral condyle fractures — Milch Types I and II for lateral (left) and medial (right) condyles. "
        "Source: Miller's Review of Orthopaedics 9th Ed., p.903",
        styles["caption"]))

    milch_data = [
        ["Type", "Lateral Condyle", "Medial Condyle", "Stability", "Treatment"],
        ["Type I", "Lateral trochlear ridge INTACT", "Medial trochlear ridge INTACT", "Stable (hinge intact)", "Immobilise in supination (lat) or pronation (med)"],
        ["Type II", "Fracture THROUGH lateral trochlear ridge", "Fracture THROUGH medial trochlear ridge", "UNSTABLE — elbow may dislocate", "ORIF"],
    ]
    story.append(styled_table(milch_data, [1.8*cm, 3.5*cm, 3.5*cm, 2.5*cm, 5.9*cm]))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("B. Supracondylar Fractures (Pediatric) — Gartland Classification", styles["subsection"]))
    gartland_data = [
        ["Gartland Type", "Description", "Periosteal Hinge", "Treatment"],
        ["Type I",  "Nondisplaced or minimally displaced",  "Intact",   "Above-elbow cast 3 weeks"],
        ["Type II", "Displaced with posterior cortex intact","Intact posteriorly",  "Closed reduction + cast; K-wire if unstable"],
        ["Type III","Completely displaced, no cortical contact","Absent", "CRPP (percutaneous K-wires) mandatory"],
        ["Type IV", "Multidirectional instability (Leitch modification)","Circumferentially disrupted","CRPP in OR"],
    ]
    story.append(styled_table(gartland_data, [3*cm, 5*cm, 3.7*cm, 5.5*cm]))
    story.append(Spacer(1, 0.2*cm))
    accent_txt = ("<b>Feared complication:</b> Volkmann's ischemic contracture (missed compartment syndrome). "
                  "Avoid deep elbow flexion if significant swelling present.<br/>"
                  "<b>Neurovascular check:</b> White pulseless hand = surgical emergency; "
                  "Pink pulseless hand = reduce first, reassess.")
    story.append(accent_box(accent_txt, styles, bg=C_RED_LIGHT))
    story.append(PageBreak())

# ── Section 4: Radial Head ───────────────────────────────────────────────────
def build_radial_head(story, styles, paths):
    story.append(section_banner("SECTION 4 — RADIAL HEAD FRACTURES (MASON CLASSIFICATION)", styles))
    story.append(Spacer(1, 0.3*cm))
    story.append(Paragraph(
        "Radial head fractures are the most common elbow fracture in adults. The Mason classification "
        "(modified by Broberg & Morrey, and Johnston) guides treatment decisions.",
        styles["body"]))
    story.append(Spacer(1, 0.3*cm))

    mason_row = [[
        Table([[
            Paragraph("<b>Type I — Nondisplaced</b>", styles["key_point"]),
            img(paths, "mason_I", width=5*cm),
            Paragraph("Marginal fracture, nondisplaced", styles["caption"]),
        ]], style=[("ALIGN",(0,0),(-1,-1),"CENTER")]),
        Table([[
            Paragraph("<b>Type III — Comminuted</b>", styles["key_point"]),
            img(paths, "mason_III", width=5*cm),
            Paragraph("Entire head involved, 3+ fragments", styles["caption"]),
        ]], style=[("ALIGN",(0,0),(-1,-1),"CENTER")]),
    ]]
    story.append(Table(mason_row, colWidths=[8.6*cm, 8.6*cm]))
    story.append(Paragraph(
        "Figure 8. Mason Classification Types I and III. Source: Miller's Review of Orthopaedics 9th Ed., p.904",
        styles["caption"]))

    mason_data = [
        ["Type", "Fracture Pattern", "Block to Motion", "Treatment"],
        ["I",  "Nondisplaced marginal fracture",             "None",    "Sling ≤7 days, then early ROM"],
        ["II", "Partial articular, displaced",               "May exist","ORIF if block or instability; else early ROM"],
        ["III","Comminuted, entire radial head involved",    "Usually", "≥3 fragments → radial head replacement; <3 → ORIF"],
        ["IV", "Any radial head fracture + elbow dislocation","Variable","Surgical; excision NEVER without replacement"],
    ]
    story.append(styled_table(mason_data, [1.5*cm, 5.5*cm, 3.5*cm, 6.7*cm]))
    story.append(Spacer(1, 0.2*cm))
    accent_txt = ("<b>Essex-Lopresti injury:</b> Radial head fracture + interosseous membrane disruption + DRUJ instability. "
                  "Missing this = progressive radial shortening. Always assess DRUJ when treating radial head fractures.<br/>"
                  "<b>Safe zone for ORIF:</b> 110° arc on lateral side (between radial styloid and Lister tubercle) — "
                  "arm in neutral/pronation to protect the posterior interosseous nerve (PIN).")
    story.append(accent_box(accent_txt, styles, bg=HexColor("#fff8e6")))
    story.append(PageBreak())

# ── Section 5: Forearm ───────────────────────────────────────────────────────
def build_forearm(story, styles, paths):
    story.append(section_banner("SECTION 5 — FOREARM FRACTURES", styles))
    story.append(Spacer(1, 0.3*cm))

    # Monteggia
    story.append(Paragraph("A. Monteggia Fracture-Dislocation (Bado Classification)", styles["subsection"]))
    story.append(Paragraph(
        "Proximal ulna fracture + radial head dislocation. Key rule: the apex of the ulnar fracture "
        "<b>points in the direction of radial head dislocation</b>. Missed in ~25% of cases.",
        styles["body"]))

    story.append(img(paths, "monteggia_xr", width=7*cm, max_height=9*cm))
    story.append(Paragraph(
        "Figure 9. Monteggia fracture-dislocation — comminuted proximal ulna with anterior radial head dislocation. "
        "Source: Tintinalli's Emergency Medicine",
        styles["caption"]))

    bado_data = [
        ["Bado Type", "Ulna Fracture", "Radial Head Direction", "Frequency", "Population"],
        ["I",  "Apex anterior angulation",      "Anterior dislocation",      "Most common in children", "Children"],
        ["II", "Apex posterior angulation",     "Posterior dislocation",     "Up to 80% in adults",     "Adults (most common)"],
        ["III","Metaphyseal fracture",           "Lateral dislocation",       "Rare",                    "Almost exclusively children"],
        ["IV", "Proximal ulna + proximal radius","Anterior dislocation",     "Rare",                    "Adults only"],
    ]
    story.append(styled_table(bado_data, [1.8*cm, 4.5*cm, 4.2*cm, 3.5*cm, 3.2*cm]))
    story.append(Spacer(1, 0.2*cm))
    story.append(accent_box(
        "<b>Treatment:</b> All Monteggia fractures in adults → ORIF of ulna. "
        "Radial head usually reduces spontaneously after anatomic ulna reduction. "
        "If not → nonanatomic ulna reduction is the most common cause; open reduction via separate approach if ulna is anatomic.",
        styles, bg=C_LIGHT))
    story.append(Spacer(1, 0.4*cm))

    # Galeazzi
    story.append(HRFlowable(width="100%", thickness=1, color=C_TEAL))
    story.append(Spacer(1, 0.2*cm))
    story.append(Paragraph("B. Galeazzi Fracture-Dislocation", styles["subsection"]))
    story.append(Paragraph(
        "Distal radial shaft fracture + DRUJ dislocation. Also called 'fracture of necessity' "
        "because ORIF is always required. Reverse of Monteggia: <b>radius fractures, ulna dislocates</b>.",
        styles["body"]))

    story.append(img(paths, "galeazzi_xr", width=14*cm, max_height=7*cm))
    story.append(Paragraph(
        "Figure 10. Galeazzi fracture-dislocation — radial shaft fracture with DRUJ disruption (AP and lateral). "
        "Source: Tintinalli's Emergency Medicine",
        styles["caption"]))

    galeazzi_data = [
        ["Sub-type", "Fracture Location", "DRUJ Instability Risk", "Notes"],
        ["Type I",   "Within 7.5 cm of radial articular surface",  "HIGH",   "More frequent DRUJ irreducibility"],
        ["Type II",  "More than 7.5 cm proximal",                  "Lower",  "ORIF still required"],
        ["Complex",  "Irreducible DRUJ after radial fixation",      "HIGH",   "ECU/EDM tendon interposition; needs open DRUJ reduction"],
    ]
    story.append(styled_table(galeazzi_data, [2.5*cm, 5.5*cm, 4.5*cm, 4.7*cm]))
    story.append(Spacer(1, 0.3*cm))

    # Comparison table
    story.append(Paragraph("Monteggia vs. Galeazzi — Comparison", styles["subsection"]))
    compare_data = [
        ["Feature",           "Monteggia",                    "Galeazzi"],
        ["Bones broken",      "Ulna (proximal)",              "Radius (distal third)"],
        ["Dislocation",       "Radial head (proximal RU joint)","Distal ulna (DRUJ)"],
        ["Mnemonic",          "Ulna fxd, Radial head dislocates","Radius fxd, Distal ulna dislocates"],
        ["Treatment",         "ORIF ulna; closed reduction RH","ORIF radius; assess DRUJ"],
        ["Also called",       "—",                            "Fracture of necessity / Piedmont"],
    ]
    story.append(styled_table(compare_data, [4*cm, 6.6*cm, 6.6*cm]))
    story.append(PageBreak())

# ── Section 6: Distal Radius ─────────────────────────────────────────────────
def build_distal_radius(story, styles, paths):
    story.append(section_banner("SECTION 6 — DISTAL RADIUS FRACTURES", styles))
    story.append(Spacer(1, 0.3*cm))
    story.append(Paragraph(
        "Distal radius fractures are the most common fracture in adults (~15% of all adult fractures). "
        "Peak incidence in elderly women (osteoporosis) and young adults (high-energy trauma).",
        styles["body"]))
    story.append(Spacer(1, 0.2*cm))

    story.append(Paragraph("OTA/AO Classification (Most Widely Used — 27 Patterns)", styles["key_point"]))
    story.append(img(paths, "distal_radius", width=16*cm, max_height=9.5*cm))
    story.append(Paragraph(
        "Figure 11. OTA/AO classification of distal radius fractures — Groups A (extra-articular), "
        "B (partial articular), C (complete articular) with 9 subgroups each. "
        "Source: Rockwood & Green's Fractures in Adults 10th Ed. 2025",
        styles["caption"]))

    ota_data = [
        ["OTA Group", "Articular Involvement", "Sub-types", "Classic Eponym"],
        ["A — Extra-articular",    "None",          "A1: ulnar styloid; A2: simple; A3: comminuted",   "Colles' (dorsal angulation)\nSmith's (volar angulation)"],
        ["B — Partial articular",  "Partial",       "B1: sagittal; B2: dorsal rim; B3: volar rim",     "Barton's (shear)\nChauffeur's (radial styloid)"],
        ["C — Complete articular", "Full articular","C1: simple; C2: metaphyseal comminution; C3: articular comminution", "Die-punch\nExplosion fracture"],
    ]
    story.append(styled_table(ota_data, [3.8*cm, 3.8*cm, 5.8*cm, 3.8*cm]))
    story.append(Spacer(1, 0.2*cm))

    eponym_data = [
        ["Eponym", "Mechanism", "Displacement", "Classic Description"],
        ["Colles'",   "FOOSH",             "Dorsal (dinner fork deformity)",  "Most common; extra-articular; age >50"],
        ["Smith's",   "Fall on flexed wrist","Volar (garden spade deformity)","Reverse Colles'"],
        ["Barton's",  "Shear / FOOSH",     "Dorsal or volar rim fragment",    "Intra-articular; rim fracture-dislocation"],
        ["Chauffeur's","Radial styloid compression","Radial styloid",         "Avulsion; associated scapholunate injury"],
        ["Die-punch", "Axial load",        "Lunate facet impaction",          "Intra-articular depression"],
    ]
    story.append(Spacer(1, 0.2*cm))
    story.append(Paragraph("Named Eponyms of Distal Radius Fractures", styles["key_point"]))
    story.append(styled_table(eponym_data, [2.8*cm, 3.5*cm, 4.5*cm, 6.4*cm]))
    story.append(PageBreak())

# ── Section 7: Scaphoid ──────────────────────────────────────────────────────
def build_scaphoid(story, styles, paths):
    story.append(section_banner("SECTION 7 — SCAPHOID FRACTURES", styles))
    story.append(Spacer(1, 0.3*cm))
    story.append(Paragraph(
        "Scaphoid fractures are the most common carpal bone fracture (~60% of carpal fractures). "
        "Mechanism: fall on outstretched hand (FOOSH). Up to 20% are initially radiograph-negative — "
        "treat on clinical suspicion (anatomical snuffbox tenderness).",
        styles["body"]))
    story.append(Spacer(1, 0.2*cm))

    scaph_data = [
        ["Location", "Frequency", "Blood Supply", "Healing Rate", "Avg. Healing Time", "AVN Risk"],
        ["Distal pole",  "10%",  "Good (from distal)",   "~100%",  "6–8 weeks",   "Low"],
        ["Waist",        "70%",  "Retrograde",           "80–90%", "10–12 weeks", "Moderate"],
        ["Proximal pole","20%",  "Poor (retrograde, enters distally)", "60–70%", "12–20 weeks", "HIGH (~30%)"],
    ]
    story.append(styled_table(scaph_data, [2.8*cm, 2.3*cm, 3.6*cm, 2.8*cm, 3.2*cm, 2.5*cm]))
    story.append(Spacer(1, 0.2*cm))

    herbert_data = [
        ["Herbert Classification", "Description", "Stability", "Treatment"],
        ["Type A1", "Fracture of tubercle",                      "Stable",   "Cast 4–6 weeks"],
        ["Type A2", "Incomplete fracture of waist",              "Stable",   "Cast 6–10 weeks (long arm initially)"],
        ["Type B1", "Oblique fracture of distal third",          "Unstable", "ORIF (headless compression screw)"],
        ["Type B2", "Complete fracture of waist, displaced",     "Unstable", "ORIF"],
        ["Type B3", "Proximal pole fracture",                    "Unstable", "ORIF; high AVN risk"],
        ["Type B4", "Trans-scaphoid perilunate fracture-dislocation", "Unstable", "ORIF + ligament repair"],
        ["Type C",  "Delayed union (>3 months)",                 "—",        "ORIF + bone graft"],
        ["Type D1", "Fibrous nonunion",                          "—",        "ORIF + bone graft"],
        ["Type D2", "Sclerotic nonunion",                        "—",        "ORIF + structural graft (Russe/Fernandez)"],
    ]
    story.append(Paragraph("Herbert Classification", styles["key_point"]))
    story.append(styled_table(herbert_data, [3*cm, 5.7*cm, 2.7*cm, 5.8*cm]))
    story.append(Spacer(1, 0.2*cm))

    accent_txt = ("<b>Diagnostic tip:</b> Normal radiographs with anatomical snuffbox tenderness → "
                  "immobilise and repeat X-ray at 10–14 days. If still negative and symptomatic → MRI (most sensitive) or CT or bone scan.<br/>"
                  "<b>Displacement threshold:</b> ≥1 mm displacement or angulation on CT → ORIF (headless compression screw).")
    story.append(accent_box(accent_txt, styles, bg=HexColor("#fff8e6")))
    story.append(PageBreak())

# ── Section 8: Pediatric ─────────────────────────────────────────────────────
def build_pediatric(story, styles, paths):
    story.append(section_banner("SECTION 8 — PEDIATRIC FRACTURES", styles))
    story.append(Spacer(1, 0.3*cm))
    story.append(Paragraph(
        "Children's bones are more porous and have active growth plates (physes). Periosteum is thicker and stronger "
        "than in adults, allowing incomplete fractures that are unique to pediatrics. Significant remodelling potential "
        "exists, particularly in the plane of joint motion and in younger patients.",
        styles["body"]))
    story.append(Spacer(1, 0.3*cm))

    ped_row = [[
        img(paths, "ped_radius_a", width=7.5*cm, max_height=7*cm),
        img(paths, "ped_radius_b", width=7.5*cm, max_height=7*cm),
    ]]
    story.append(Table(ped_row, colWidths=[8.6*cm, 8.6*cm]))
    story.append(Paragraph(
        "Figure 12. (a) Dorsally angulated metaphyseal radius fracture (buckle/torus) in a 10-year-old. "
        "(b) Post-reduction at 8 weeks. (c) Complete remodelling at age 12. Source: Bailey & Love's 28th Ed.",
        styles["caption"]))
    story.append(Spacer(1, 0.3*cm))

    ped_data = [
        ["Fracture Type", "Description", "Common Location", "Treatment"],
        ["Buckle (Torus)",  "Cortex buckles/bulges; no complete cortical break",  "Distal radius/ulna metaphysis",  "Cast 3–4 weeks; excellent prognosis"],
        ["Greenstick",      "Incomplete fracture — one cortex breaks, one bends", "Radius/ulna diaphysis",          "Reduction if >15° angulation; cast"],
        ["Plastic deformation","Bone bends without visible fracture line",        "Radius, ulna, fibula",           "Reduction under GA if significant deformity"],
        ["Complete",        "Both cortices disrupted",                            "Any long bone",                  "Reduction ± fixation depending on site"],
    ]
    story.append(styled_table(ped_data, [3.2*cm, 5.5*cm, 4*cm, 4.5*cm]))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("Salter-Harris Classification of Physeal Injuries", styles["subsection"]))
    sh_data = [
        ["Type", "Mnemonic (SALTR)", "Fracture Pattern", "Prognosis", "Treatment"],
        ["I",   "S — Straight across",    "Physis only; through growth plate",                  "Excellent",       "Immobilisation"],
        ["II",  "A — Above (metaphysis)", "Through physis + into metaphysis (most common ~75%)", "Excellent",       "Closed reduction ± K-wires"],
        ["III", "L — Lower (epiphysis)",  "Through physis + down through epiphysis (articular)", "Guarded",         "ORIF (intra-articular)"],
        ["IV",  "T — Through all",        "Through metaphysis + physis + epiphysis",             "Poor without ORIF","ORIF mandatory"],
        ["V",   "R — Rammed/crush",       "Crush injury to physis",                             "Poor; growth arrest likely","Immobilisation; warn of arrest"],
    ]
    story.append(styled_table(sh_data, [1.5*cm, 3.5*cm, 5.5*cm, 2.8*cm, 3.9*cm]))
    story.append(Spacer(1, 0.2*cm))
    accent_txt = ("<b>Salter-Harris key rules:</b><br/>"
                  "• Types I & II = extra-articular → closed treatment usually sufficient<br/>"
                  "• Types III & IV = intra-articular → anatomic reduction essential to prevent growth arrest and DJD<br/>"
                  "• Type V = most dangerous; diagnosis often made retrospectively when growth arrest is evident<br/>"
                  "• Growth arrest is the main long-term complication; corrective osteotomy may be needed")
    story.append(accent_box(accent_txt, styles, bg=C_RED_LIGHT))
    story.append(PageBreak())

# ── Section 9: Quick Reference ───────────────────────────────────────────────
def build_quick_ref(story, styles, paths):
    story.append(section_banner("SECTION 9 — QUICK REFERENCE COMPARISON TABLE", styles))
    story.append(Spacer(1, 0.3*cm))

    qr_data = [
        ["Fracture", "Best Classification", "Key Sub-types / Types", "Most Common Pattern", "Must-Know Complication"],
        ["Clavicle",           "Robinson",        "Type 1 (medial), 2 (shaft), 3 (distal)",            "Middle third (80%)",           "Nonunion if >100% displacement"],
        ["Distal clavicle",    "Neer/Rockwood",   "I (intact CC), IIA, IIB (CC disrupted), III (AC)",  "Type II (unstable)",           "Nonunion; malunion"],
        ["Scapula",            "Ada-Miller",      "I (processes), II (neck), III (glenoid), IV (body)", "Body fractures (~50%)",        "Associated injuries (rib, lung, BPI)"],
        ["Proximal humerus",   "Neer (4-part)",   "1-part to 4-part + head-split",                     "1-part (undisplaced) = 80%",   "AVN (esp. 4-part); screw cutout"],
        ["Humeral shaft",      "OTA/AO 12",       "A=simple, B=wedge, C=complex",                      "Spiral/oblique middle third",  "Radial nerve palsy (5-22%)"],
        ["Distal humerus",     "Milch / Gartland","Milch I/II; Gartland I-IV (pediatric supracondylar)","Supracondylar (children)",    "Volkmann's contracture; cubitus varus"],
        ["Radial head",        "Mason (I-IV)",    "I=nondisplaced, II=partial, III=comminuted, IV=+disloc","Type I most common",      "Essex-Lopresti (missed DRUJ injury)"],
        ["Monteggia",          "Bado (I-IV)",     "I=anterior, II=posterior, III=lateral, IV=anterior+radius","Type I (children), II (adults)","Missed radial head dislocation; PIN palsy"],
        ["Galeazzi",           "Type I/II",       "By distance from articular surface (<7.5 cm vs >7.5 cm)","Middle-distal radius",    "DRUJ malunion; ECU interposition"],
        ["Distal radius",      "OTA/AO A/B/C",   "A=extra-articular, B=partial, C=complete articular", "Colles' (A2)",               "Malunion with dorsal angulation; CRPS"],
        ["Scaphoid",           "Herbert (A-D)",   "A=stable, B=unstable, C=delayed union, D=nonunion",  "Waist fracture (70%)",        "AVN of proximal pole; nonunion"],
        ["Pediatric forearm",  "Descriptive + Salter-Harris", "Buckle / Greenstick / SH I-V",          "Buckle (torus) distal radius", "Growth arrest (SH III-V); physeal bar"],
    ]
    story.append(styled_table(qr_data, [3.2*cm, 3*cm, 5.3*cm, 3.3*cm, 2.4*cm]))
    story.append(Spacer(1, 0.4*cm))

    # Final tips box
    tips_data = [[
        Paragraph(
            "<b>HIGH-YIELD MNEMONICS &amp; RULES</b><br/><br/>"
            "<b>Monteggia vs Galeazzi:</b> Ulnar shaft fracture → Monteggia (Radial head dislocates). "
            "Radial shaft fracture → Galeazzi (distal Ulna dislocates). Mnemonic: <b>MUGR</b> "
            "(Monteggia = Ulnar fracture + RH dislocation; Galeazzi = Radial fracture + DRUJ dislocation)<br/><br/>"
            "<b>Salter-Harris:</b> <b>SALTR</b> = Straight / Above / Lower / Through / Rammed<br/><br/>"
            "<b>Scaphoid blood supply:</b> Enters distally → retrograde to proximal pole → "
            "waist fracture cuts off proximal pole blood supply = AVN risk<br/><br/>"
            "<b>Neer 'part' definition:</b> >1 cm displacement OR >45° angulation<br/><br/>"
            "<b>Bado's rule:</b> Apex of ulna fracture points toward direction of radial head dislocation",
            styles["body"])
    ]]
    tips_t = Table(tips_data, colWidths=[17.2*cm])
    tips_t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0),(-1,-1), HexColor("#e8f8e8")),
        ("BOX",           (0,0),(-1,-1), 1.5, C_TEAL),
        ("TOPPADDING",    (0,0),(-1,-1), 12),
        ("BOTTOMPADDING", (0,0),(-1,-1), 12),
        ("LEFTPADDING",   (0,0),(-1,-1), 14),
        ("RIGHTPADDING",  (0,0),(-1,-1), 14),
    ]))
    story.append(tips_t)

# ── Page template (header/footer) ────────────────────────────────────────────
def on_page(canvas, doc):
    canvas.saveState()
    w, h = A4
    # Header bar
    canvas.setFillColor(C_NAVY)
    canvas.rect(0, h - 25, w, 25, fill=1, stroke=0)
    canvas.setFillColor(white)
    canvas.setFont("Helvetica-Bold", 9)
    canvas.drawString(20, h - 16, "FRACTURE CLASSIFICATIONS — Study Guide")
    canvas.setFont("Helvetica", 8)
    canvas.drawRightString(w - 20, h - 16, "Orris Medical Library")
    # Footer
    canvas.setFillColor(C_TEAL)
    canvas.rect(0, 0, w, 18, fill=1, stroke=0)
    canvas.setFillColor(white)
    canvas.setFont("Helvetica", 8)
    canvas.drawString(20, 5, "Sources: Miller's Review of Orthopaedics | Rockwood & Green's | Tintinalli's | Bailey & Love's | Campbell's")
    canvas.drawRightString(w - 20, 5, f"Page {doc.page}")
    canvas.restoreState()

# ── Main builder ─────────────────────────────────────────────────────────────
def main():
    print("Downloading images…")
    paths = download_images()

    print("Building PDF…")
    doc = SimpleDocTemplate(
        OUTPUT,
        pagesize=A4,
        leftMargin=2*cm, rightMargin=2*cm,
        topMargin=2.5*cm, bottomMargin=1.5*cm,
        title="Fracture Classifications Study Guide",
        author="Orris Medical Library",
    )

    styles = make_styles()
    story  = []

    build_cover(story, styles)
    build_shoulder(story, styles, paths)
    build_prox_humerus(story, styles, paths)
    build_distal_humerus(story, styles, paths)
    build_radial_head(story, styles, paths)
    build_forearm(story, styles, paths)
    build_distal_radius(story, styles, paths)
    build_scaphoid(story, styles, paths)
    build_pediatric(story, styles, paths)
    build_quick_ref(story, styles, paths)

    doc.build(story, onFirstPage=on_page, onLaterPages=on_page)
    print(f"Done → {OUTPUT}")

if __name__ == "__main__":
    main()

Running Command

cd /home/daytona/workspace/fracture-study-guide && python3 build_pdf.py 2>&1

Running Command

ls -lh /home/daytona/workspace/fracture-study-guide/Fracture_Classifications_Stu…

Your study guide PDF is ready — 5.6 MB, A4 format with 9 sections.

Fracture Classifications Study Guide

PDF Document · PDF

What's inside (9 sections, ~12 pages):

Section	Content
Cover + TOC	Colour-coded table of contents with all fractures
1. Shoulder Girdle	Robinson + Neer clavicle diagrams; Ada-Miller scapula; OTA/AO glenoid
2. Proximal Humerus	Neer 4-part diagram with muscle vectors; AVN risk table
3. Distal Humerus	Milch condyle diagram; Gartland supracondylar classification
4. Radial Head	Mason I/III illustrations; Essex-Lopresti note
5. Forearm	Monteggia X-ray + Bado table; Galeazzi X-ray + comparison table
6. Distal Radius	Full OTA/AO 27-pattern diagram; eponym comparison table
7. Scaphoid	Blood supply by location; Herbert classification A-D
8. Pediatric	Buckle/greenstick X-rays; Salter-Harris SALTR table
9. Quick Reference	Master comparison table of all 12 fractures + high-yield mnemonics

Each section includes: clinical diagram, classification table, colour-coded highlighted boxes for key points and complications.

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