import math
from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.enum.shapes import MSO_SHAPE
from pptx.oxml.ns import qn
from lxml import etree
from PIL import Image

WARN = []


def rgb(h):
    h = h.lstrip('#')
    return RGBColor(int(h[0:2], 16), int(h[2:4], 16), int(h[4:6], 16))


def new_prs():
    prs = Presentation()
    prs.slide_width = Inches(13.333)
    prs.slide_height = Inches(7.5)
    return prs


def blank(prs, bg):
    s = prs.slides.add_slide(prs.slide_layouts[6])
    f = s.background.fill
    f.solid()
    f.fore_color.rgb = rgb(bg)
    return s


def shape(slide, kind, x, y, w, h, fill=None, line=None, lw=1.0):
    sh = slide.shapes.add_shape(kind, Inches(x), Inches(y), Inches(w), Inches(h))
    if fill:
        sh.fill.solid()
        sh.fill.fore_color.rgb = rgb(fill)
    else:
        sh.fill.background()
    if line:
        sh.line.color.rgb = rgb(line)
        sh.line.width = Pt(lw)
    else:
        sh.line.fill.background()
    sh.shadow.inherit = False
    return sh


def rect(slide, x, y, w, h, fill=None, line=None, lw=1.0):
    return shape(slide, MSO_SHAPE.RECTANGLE, x, y, w, h, fill, line, lw)


def rrect(slide, x, y, w, h, fill=None, line=None, lw=1.0, adj=0.08):
    sh = shape(slide, MSO_SHAPE.ROUNDED_RECTANGLE, x, y, w, h, fill, line, lw)
    sh.adjustments[0] = adj
    return sh


def circle(slide, cx, cy, d, fill=None, line=None, lw=1.0):
    return shape(slide, MSO_SHAPE.OVAL, cx - d / 2, cy - d / 2, d, d, fill, line, lw)


def est_height(paras, w, font_scale=0.50):
    """paras: list of (text, size_pt, space_after_pt, indent_in)"""
    tot = 0
    for t, size, sa, ind in paras:
        cpl = max(1, (w - ind) * 72 / (size * font_scale * 1.0))
        lines = max(1, math.ceil(len(t) / cpl))
        tot += lines * size * 1.2 / 72 + sa / 72
    return tot


def _style_run(r, size, color, bold=False, italic=False, font=None):
    r.font.size = Pt(size)
    r.font.bold = bold
    r.font.italic = italic
    r.font.color.rgb = rgb(color)
    if font:
        r.font.name = font


def tb(slide, x, y, w, h, text, size=16, color='000000', bold=False, italic=False,
       align='l', anchor='t', font='Calibri', check=True, tag=''):
    box = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = box.text_frame
    tf.word_wrap = True
    tf.margin_left = tf.margin_right = Inches(0.05)
    tf.margin_top = tf.margin_bottom = Inches(0.03)
    tf.vertical_anchor = {'t': MSO_ANCHOR.TOP, 'm': MSO_ANCHOR.MIDDLE, 'b': MSO_ANCHOR.BOTTOM}[anchor]
    lines = text if isinstance(text, list) else [text]
    for i, ln in enumerate(lines):
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        p.alignment = {'l': PP_ALIGN.LEFT, 'c': PP_ALIGN.CENTER, 'r': PP_ALIGN.RIGHT}[align]
        r = p.add_run()
        r.text = ln
        _style_run(r, size, color, bold, italic, font)
    if check:
        fs = 0.56 if font in ('Georgia', 'Cambria') else 0.50
        if bold:
            fs += 0.04
        eh = est_height([(l, size, 0, 0) for l in lines], w - 0.1, fs)
        if eh > h + 0.08:
            WARN.append(f'TEXT overflow {tag} "{lines[0][:40]}" est {eh:.2f} > {h:.2f}')
    return box


def bullets(slide, x, y, w, h, items, size=16, color='222222', bucolor='C8A02A', lead_color=None,
            space=6, bu='\u25CF', font='Calibri', tag=''):
    box = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = box.text_frame
    tf.word_wrap = True
    tf.margin_left = tf.margin_right = Inches(0.05)
    tf.margin_top = tf.margin_bottom = Inches(0.03)
    est = []
    first = True
    for it in items:
        lvl = 0
        if isinstance(it, tuple):
            it, lvl = it
        p = tf.paragraphs[0] if first else tf.add_paragraph()
        first = False
        sz = size if lvl == 0 else size - 2
        lead, rest = (it.split('||', 1) + [''])[:2] if '||' in it else ('', it)
        if lead:
            r = p.add_run()
            r.text = lead + ': '
            _style_run(r, sz, lead_color or color, True, False, font)
        r = p.add_run()
        r.text = rest
        _style_run(r, sz, color, False, False, font)
        p.space_after = Pt(space)
        ind = 0.26 if lvl == 0 else 0.5
        pPr = p._p.get_or_add_pPr()
        pPr.set('marL', str(int(Inches(ind))))
        pPr.set('indent', str(-int(Inches(0.24))))
        buClr = etree.SubElement(pPr, qn('a:buClr'))
        c = etree.SubElement(buClr, qn('a:srgbClr'))
        c.set('val', bucolor)
        buSz = etree.SubElement(pPr, qn('a:buSzPct'))
        buSz.set('val', '70000')
        ch = etree.SubElement(pPr, qn('a:buChar'))
        ch.set('char', bu if lvl == 0 else '\u25CB')
        est.append(((lead + ': ' if lead else '') + rest, sz, space, ind))
    eh = est_height(est, w - 0.1, 0.51)
    if eh > h + 0.05:
        WARN.append(f'BULLETS overflow {tag} est {eh:.2f} > {h:.2f}')
    return box


def pic(slide, path, x, y, w, h, frame=None, caption=None, cap_color='555555', cap_size=10,
        pad=0.06, bg='FFFFFF', align='c'):
    """fit image within box (x,y,w,h); draws frame; returns bottom y."""
    im = Image.open(path)
    iw, ih = im.size
    ch = 0.3 if caption else 0
    bw, bh = w - 2 * pad, h - 2 * pad - ch
    sc = min(bw / iw, bh / ih)
    dw, dh = iw * sc, ih * sc
    fx = x + (w - (dw + 2 * pad)) / 2
    fy = y
    if frame is not None:
        rect(slide, fx, fy, dw + 2 * pad, dh + 2 * pad, bg, frame, 1.25)
    slide.shapes.add_picture(path, Inches(fx + pad), Inches(fy + pad), Inches(dw), Inches(dh))
    if caption:
        tb(slide, x, fy + dh + 2 * pad + 0.02, w, 0.5, caption, cap_size, cap_color, italic=True, align='c',
           check=False)
    return fy + dh + 2 * pad


def circ_pic(slide, path, cx, cy, d, line='C8A02A', lw=3.0, focus=(0.5, 0.5)):
    im = Image.open(path)
    iw, ih = im.size
    side = min(iw, ih)
    pic_ = slide.shapes.add_picture(path, Inches(cx - d / 2), Inches(cy - d / 2), Inches(d), Inches(d))
    # crop to square around focus
    if iw > ih:
        extra = (iw - side) / iw
        l = extra * focus[0] * 2
        l = min(max(l, 0), extra)
        pic_.crop_left = l
        pic_.crop_right = extra - l
    else:
        extra = (ih - side) / ih
        t = min(max(extra * focus[1] * 2, 0), extra)
        pic_.crop_top = t
        pic_.crop_bottom = extra - t
    pic_.auto_shape_type = MSO_SHAPE.OVAL
    pic_.line.color.rgb = rgb(line)
    pic_.line.width = Pt(lw)
    return pic_


def table(slide, x, y, w, rows, colw, rowh, hdr_fill, hdr_color, fills, text_color, size=13, hdr_size=13,
          font='Calibri', bold_first_col=True, border='FFFFFF'):
    nr, nc = len(rows), len(rows[0])
    gs = slide.shapes.add_table(nr, nc, Inches(x), Inches(y), Inches(w), Inches(rowh * nr))
    t = gs.table
    # strip default style banding
    tblPr = t._tbl.tblPr
    tblPr.set('firstRow', '0')
    tblPr.set('bandRow', '0')
    tot = sum(colw)
    for i, cw in enumerate(colw):
        t.columns[i].width = Inches(w * cw / tot)
    total_h = 0
    for r in range(nr):
        rh = rowh[r] if isinstance(rowh, list) else rowh
        t.rows[r].height = Inches(rh)
        # estimate needed
        need = 0
        for c in range(nc):
            cw = w * colw[c] / tot - 0.2
            sz = hdr_size if r == 0 else size
            need = max(need, est_height([(rows[r][c], sz, 0, 0)], cw, 0.52) + 0.14)
        if need > rh + 0.02:
            WARN.append(f'TABLE row {r} "{rows[r][0][:25]}" needs {need:.2f} > {rh:.2f}')
        total_h += max(rh, need)
        for c in range(nc):
            cell = t.cell(r, c)
            cell.margin_left = cell.margin_right = Inches(0.08)
            cell.margin_top = cell.margin_bottom = Inches(0.04)
            cell.vertical_anchor = MSO_ANCHOR.MIDDLE
            cell.fill.solid()
            if r == 0:
                cell.fill.fore_color.rgb = rgb(hdr_fill)
            else:
                cell.fill.fore_color.rgb = rgb(fills[(r - 1) % len(fills)])
            tf = cell.text_frame
            tf.word_wrap = True
            p = tf.paragraphs[0]
            run = p.add_run()
            run.text = rows[r][c]
            if r == 0:
                _style_run(run, hdr_size, hdr_color, True, False, font)
            else:
                _style_run(run, size, text_color, bold_first_col and c == 0, False, font)
    return total_h


def notes(slide, text):
    slide.notes_slide.notes_text_frame.text = text


def check_bounds(prs, name):
    W, H = prs.slide_width, prs.slide_height
    for i, s in enumerate(prs.slides, 1):
        for sh in s.shapes:
            if sh.width is None:
                continue
            if sh.left + sh.width > W + 20000 or sh.top + sh.height > H + 20000 or sh.left < -20000 or sh.top < -20000:
                if sh.shape_type == 13 or (sh.has_text_frame and sh.text_frame.text.strip()):
                    WARN.append(f'{name} slide {i}: shape out of bounds {sh.name}')

import sys
sys.path.insert(0, '/tmp/workspace/ortho-decks')
from lib import *

A = '/tmp/workspace/ortho-decks/assets/'
DARK, CREAM, GOLD, DEEP, LIGHT, MID, TXT, GREY = '1E1A10', 'FBF7EC', 'C8A02A', '8C6D12', 'F5EBC8', 'EBD58A', '2A2315', '6B6250'
SHORT = 'Clavicle Fractures  |  Orthopaedic Resident Teaching'
prs = new_prs()
pg = [1]


def content(title, size=28):
    s = blank(prs, CREAM)
    pg[0] += 1
    circle(s, 12.95, 0.25, 2.3, LIGHT)
    circle(s, 11.75, 0.0, 0.9, MID)
    circle(s, 13.1, 7.4, 1.6, LIGHT)
    circle(s, 0.95, 0.78, 0.7, GOLD)
    tb(s, 0.6, 0.55, 0.7, 0.45, str(pg[0]), 18, 'FFFFFF', True, align='c', anchor='m', font='Georgia', check=False)
    tb(s, 1.45, 0.4, 10.1, 0.8, title, size, DEEP, True, anchor='m', font='Georgia', tag='title:' + title)
    rect(s, 0.7, 1.33, 11.93, 0.025, GOLD)
    circle(s, 0.7, 1.345, 0.16, GOLD)
    circle(s, 12.63, 1.345, 0.16, GOLD)
    tb(s, 0.7, 7.08, 8, 0.3, SHORT, 10, GREY, check=False)
    return s


def card(s, x, y, w, h, head, body_items, size=14, head_fill=DEEP, bg='FFFFFF'):
    rrect(s, x, y, w, h, bg, GOLD, 1.25, 0.04)
    rrect(s, x, y, w, 0.5, head_fill, None, 0, 0.3)
    tb(s, x + 0.1, y + 0.02, w - 0.2, 0.46, head, 15, 'FFFFFF', True, anchor='m', font='Georgia', tag='cardhead')
    bullets(s, x + 0.15, y + 0.62, w - 0.3, h - 0.7, body_items, size, TXT, GOLD, DEEP, 5, tag='card:' + head)


def stat(s, cx, cy, d, big, label, lw=2.2, fs=22, lab_w=2.6, lab_h=0.75, lab_size=12):
    circle(s, cx, cy, d + 0.2, None, GOLD, 1.5)
    circle(s, cx, cy, d, GOLD)
    tb(s, cx - d / 2, cy - 0.3, d, 0.6, big, fs, 'FFFFFF', True, align='c', anchor='m', font='Georgia', check=False)
    tb(s, cx - lab_w / 2, cy + d / 2 + 0.15, lab_w, lab_h, label, lab_size, TXT, align='c', tag='stat:' + big)


# ---------- 1 Title ----------
s = blank(prs, DARK)
for d, c, w in [(6.9, DEEP, 1.5), (6.0, GOLD, 1.0), (5.4, DEEP, 0.75)]:
    circle(s, 10.0, 3.75, d, None, c, w)
circ_pic(s, A + 'cl_displaced.jpg', 10.0, 3.75, 4.7, GOLD, 3.5, focus=(0.5, 0.5))
circle(s, 6.9, 6.5, 0.35, GOLD)
circle(s, 13.0, 0.5, 0.5, MID)
circle(s, 7.6, 0.9, 0.18, GOLD)
tb(s, 0.8, 1.3, 6.0, 0.4, 'ORTHOPAEDIC RESIDENT TEACHING SERIES', 14, GOLD, True, font='Calibri')
tb(s, 0.8, 1.85, 6.2, 2.3, ['Clavicle', 'Fractures'], 56, 'FFFFFF', True, font='Georgia', tag='t1')
rect(s, 0.85, 4.3, 1.6, 0.04, GOLD)
tb(s, 0.8, 4.5, 5.9, 1.0, 'Applied anatomy, classification, evidence-based management and complications', 20, 'E8DDB5',
   tag='sub')
tb(s, 0.8, 6.3, 5.8, 0.6, 'Sources: Rockwood and Green 10th ed, Campbell 15th ed, AAOS guideline 2023', 12, 'B8A96A',
   check=False)
notes(s, 'Clavicle fractures: common injury, evolving evidence base. Radiograph shows a displaced midshaft fracture.')

# ---------- 2 Objectives ----------
s = content('Learning objectives')
objs = ['Describe applied anatomy and the deforming forces', 'Recognise injury patterns and associated injuries',
        'Classify fractures: Allman, Robinson, Neer', 'Choose operative versus nonoperative care using evidence',
        'Apply fixation principles and rehabilitation', 'Manage nonunion, malunion and hardware problems']
for i, o in enumerate(objs):
    cx = 1.35 + (i % 3) * 4.1
    cy = 2.45 + (i // 3) * 2.3
    circle(s, cx, cy, 1.15, None, GOLD, 1.5)
    circle(s, cx, cy, 0.95, GOLD)
    tb(s, cx - 0.45, cy - 0.3, 0.9, 0.6, str(i + 1), 28, 'FFFFFF', True, align='c', anchor='m', font='Georgia',
       check=False)
    tb(s, cx + 0.75, cy - 0.55, 2.55, 1.1, o, 15, TXT, True, anchor='m', tag='obj')
tb(s, 0.7, 6.15, 11.9, 0.6,
   'Format: anatomy and assessment, classification, treatment decisions, surgery and rehab, complications, viva pearls.',
   14, GREY, italic=True)

# ---------- 3 Epidemiology ----------
s = content('Epidemiology')
stat(s, 1.95, 2.45, 1.4, '2.6-4%', 'of all fractures', fs=20)
stat(s, 4.95, 2.45, 1.4, '80-85%', 'midshaft: thin, curved, no muscle or ligament protection', fs=20)
stat(s, 1.95, 5.0, 1.4, '15-20%', 'distal third: older patients, simple falls', fs=20)
stat(s, 4.95, 5.0, 1.4, '0-5%', 'medial third: often high energy, easily missed', fs=20)
pic(s, A + 'cl_epi.png', 6.95, 1.65, 5.7, 3.1, GOLD,
    'Fractures by age and sex, Swedish Fracture Register (Kihlstrom et al., 2017)')
bullets(s, 6.95, 5.15, 5.7, 1.8, [
    'Incidence||29 to 64 per 100,000 per year',
    'Males||peak under 25 years, smaller second peak in middle age',
    'Females||modest peaks in teenagers and the elderly (osteoporotic falls)'], 14, TXT, GOLD, DEEP, 5, tag='epi')
notes(s, 'Figures from Rockwood and Green 10th ed (Woltz and McKee). Hippocrates advised benign neglect; modern data challenge this for displaced fractures.')

# ---------- 4 Anatomy ----------
s = content('Applied anatomy')
bullets(s, 0.7, 1.6, 7.1, 5.3, [
    'Shape||S-shaped; medial two thirds convex anteriorly, lateral third concave anteriorly',
    'Development||first bone to ossify, shaft forms by intramembranous ossification; medial physis fuses in the early to mid 20s',
    'Weak point||thin junction of middle and lateral thirds, unprotected by muscle or ligament',
    'Ligaments||sternoclavicular and costoclavicular medially; conoid and trapezoid (coracoclavicular, CC) laterally suspend the scapula',
    'Neurovascular||subclavian vessels, brachial plexus and lung apex lie behind the middle third',
    'Supraclavicular nerves||cross the bone anteriorly; injury gives numbness below the incision'],
        15, TXT, GOLD, DEEP, 7, tag='anat')
rrect(s, 8.1, 1.6, 4.53, 5.2, 'FFFFFF', GOLD, 1.25, 0.04)
tb(s, 8.2, 1.65, 4.3, 0.5, 'Deforming forces: displaced midshaft', 15, DEEP, True, font='Georgia', tag='df')
forces = [('SCM', 'Elevates the medial fragment'),
          ('Arm weight + pectoralis major', 'Pull the lateral fragment down, in and forward: shortening'),
          ('Subclavius, CC ligaments', 'Tether the lateral fragment and limit distal displacement')]
for i, (a, b) in enumerate(forces):
    cy = 2.9 + i * 1.3
    circle(s, 8.75, cy, 0.75, GOLD)
    tb(s, 8.4, cy - 0.25, 0.7, 0.5, str(i + 1), 20, 'FFFFFF', True, align='c', anchor='m', font='Georgia', check=False)
    tb(s, 9.3, cy - 0.5, 3.2, 0.35, a, 13, DEEP, True, tag='force')
    tb(s, 9.3, cy - 0.15, 3.2, 0.7, b, 12, TXT, tag='force2')
notes(s, 'Mention only 1/3 of clavicle lateral is anterior concave; medial physis is last in the body to close.')

# ---------- 5 Mechanism and associated ----------
s = content('Mechanism and associated injuries')
card(s, 0.7, 1.65, 5.8, 5.2, 'Mechanisms', [
    'Fall onto the point of the shoulder||most common',
    'Direct blow||contact sport, seatbelt, assault',
    'High energy||cycling, motorcycle, football, hockey; young males',
    'Low energy||elderly: distal third, osteoporotic',
    'Fall on outstretched hand||uncommon',
    'Birth trauma||neonates, heals with remodelling'], 14)
card(s, 6.83, 1.65, 5.8, 5.2, 'Look for associated injuries', [
    'Ribs, pneumothorax, haemothorax||auscultate, chest film',
    'Scapula and glenoid||floating shoulder',
    'AC or SC dislocation||esp. with lateral or medial fractures',
    'Brachial plexus and subclavian vessels||rare, but document',
    'Medial third||concomitant injuries in up to 80% and mortality about 20% from head and chest trauma',
    'Skin||tenting, open wounds'], 14)

# ---------- 6 Clinical evaluation ----------
s = content('Clinical evaluation')
cols = [('H', 'History', ['Mechanism and energy', 'Dominant arm, sport, job', 'Smoking, diabetes, anticoagulants', 'Paraesthesia, dyspnoea, dysphagia', 'Previous shoulder problems']),
        ('E', 'Examination', ['Drooped, shortened shoulder', 'Step, crepitus, bruising', 'Skin tenting or wound', 'Full upper limb neurovascular exam', 'Chest auscultation, C-spine, scapula, SC and AC joints']),
        ('!', 'Red flags', ['Open fracture or threatened skin', 'Pulse deficit or expanding haematoma', 'Progressive neurological deficit', 'Pneumothorax or respiratory compromise', 'Posterior SC injury with mediastinal signs'])]
for i, (ic, h, items) in enumerate(cols):
    x = 0.7 + i * 4.05
    circle(s, x + 1.95, 2.2, 1.0, GOLD)
    tb(s, x + 1.45, 1.85, 1.0, 0.7, ic, 32, 'FFFFFF', True, align='c', anchor='m', font='Georgia', check=False)
    tb(s, x, 2.85, 3.9, 0.45, h, 18, DEEP, True, align='c', font='Georgia')
    rrect(s, x, 3.35, 3.9, 3.5, 'FFFFFF', GOLD, 1.25, 0.04)
    bullets(s, x + 0.12, 3.45, 3.66, 3.3, items, 14, TXT, GOLD, DEEP, 6, tag='clin' + h)

# ---------- 7 Imaging ----------
s = content('Imaging')
bullets(s, 0.7, 1.6, 6.3, 5.3, [
    'AP clavicle||plus 15 to 30 degree cephalic tilt to show true displacement and overlap',
    'Zanca view||lateral third; centred on AC joint with lower penetration',
    'Serendipity view or CT||medial third and SC joint',
    'CT with 3D||medial fractures, comminution, planning for nonunion or malunion',
    'Measure||shortening against the contralateral side, and displacement as a proportion of shaft width',
    'Chest film||if rib or lung injury is suspected'], 15, TXT, GOLD, DEEP, 8, tag='img')
pic(s, A + 'cl_displaced.jpg', 7.3, 1.6, 5.3, 2.85, GOLD, 'Displaced midshaft fracture, superior medial fragment')
pic(s, A + 'cl_shortening.jpg', 7.3, 4.6, 5.3, 2.2, GOLD, 'Quantifying shortening in millimetres')

# ---------- 8 Classification ----------
s = content('Classification: whole clavicle and midshaft')
rows = [['System', 'Categories', 'Comment'],
        ['Allman 1967', 'Group I middle third; II lateral third; III medial third', 'Simple, location based'],
        ['Robinson 1998', 'Type 1 medial, 2 diaphyseal, 3 lateral; A undisplaced, B displaced; 2B1 simple or wedge, 2B2 comminuted or segmental', 'Most used for midshaft; links to outcome'],
        ['OTA/AO', '15.1 medial, 15.2 diaphyseal, 15.3 lateral; A simple, B wedge, C multifragmentary', 'Research and registries']]
table(s, 0.7, 1.6, 11.93, rows, [1.6, 6.3, 3.4], [0.45, 0.6, 0.95, 0.7], DEEP, 'FFFFFF', ['FFFFFF', LIGHT], TXT, 13, 14)
pic(s, A + 'cl_allman1.jpg', 0.7, 4.65, 6.6, 2.2, GOLD, 'Allman group I with marked displacement and shortening')
rrect(s, 7.7, 4.7, 4.93, 2.1, LIGHT, GOLD, 1.25, 0.05)
tb(s, 7.85, 4.78, 4.65, 0.4, 'Why it matters', 15, DEEP, True, font='Georgia')
bullets(s, 7.85, 5.2, 4.65, 1.6, ['Displacement and shortening predict nonunion and symptomatic malunion',
                                  'Comminution (2B2) is a recognised risk factor'], 13, TXT, GOLD, DEEP, 4, tag='why')

# ---------- 9 Neer ----------
s = content('Lateral third: Neer classification')
rows = [['Type', 'Pattern', 'Stability and usual plan'],
        ['I', 'Lateral to CC ligaments; CC intact; minimal displacement', 'Stable; nonoperative'],
        ['IIA', 'Medial to CC ligaments; conoid and trapezoid attached to distal fragment', 'Unstable; consider fixation'],
        ['IIB', 'Conoid torn, trapezoid on distal fragment', 'Unstable; fixation'],
        ['III', 'Intra-articular, AC joint; CC intact', 'Usually nonoperative; late AC arthritis'],
        ['IV', 'Paediatric periosteal sleeve avulsion', 'Usually nonoperative; remodels'],
        ['V', 'Comminuted; inferior fragment held by CC ligaments', 'Unstable; fixation']]
table(s, 0.7, 1.6, 8.0, rows, [0.7, 4.3, 3.0], [0.42] + [0.72] * 6, DEEP, 'FFFFFF', ['FFFFFF', LIGHT], TXT, 12, 13)
pic(s, A + 'cl_neer5.jpg', 9.0, 1.6, 3.65, 3.1, GOLD, 'Neer type V, axillary view')
rrect(s, 9.0, 5.05, 3.65, 1.75, LIGHT, GOLD, 1.25, 0.05)
tb(s, 9.1, 5.1, 3.45, 1.65, 'Key idea: the CC ligaments keep the medial fragment from the distal one; once separated, the shaft rides up and nonunion is common.', 13, TXT, tag='neerkey')

# ---------- 10 Medial and special ----------
s = content('Medial third injuries')
bullets(s, 0.7, 1.6, 7.5, 5.3, [
    'Diagnosis||easy to miss on plain film; CT is advised (Rockwood)',
    'Look for||mediastinal structures, trachea, oesophagus, great vessels if posterior displacement',
    'Undisplaced or minimally displaced||sling and observation',
    'Posterior displacement with compression||reduce under anaesthesia with thoracic surgery available; open reduction and plate if unstable',
    'Avoid||smooth pins across the SC joint (migration risk)',
    'Children and adolescents||usually physeal injury (Salter-Harris I or II); remodelling is good'],
        15, TXT, GOLD, DEEP, 7, tag='med')
stat(s, 9.5, 2.9, 1.7, 'Up to 80%', 'have concomitant injuries (Rockwood)', fs=17, lab_w=3.2)
stat(s, 11.9, 5.2, 1.3, '~20%', 'mortality from associated head and chest trauma', fs=20, lab_w=2.4, lab_h=0.9)

# ---------- 11 Nonoperative ----------
s = content('Nonoperative treatment')
bullets(s, 0.7, 1.6, 11.9, 3.2, [
    'Indications||undisplaced or minimally displaced midshaft; Neer I and III; low-demand patients; informed preference',
    'Sling for comfort||until pain settles, usually 1 to 3 weeks; figure-of-eight bandage offers no advantage over a sling',
    'Early motion||pendulums, then active-assisted range as pain allows',
    'Restrictions||no heavy lifting, pushing or pulling for about 6 weeks',
    'Follow-up||films at 1 to 2 weeks if displaced, then at about 6 weeks; counsel on nonunion, malunion and a visible lump'],
        15, TXT, GOLD, DEEP, 6, tag='nonop')
steps = [('0-2 wk', 'Sling, pendulums'), ('2-6 wk', 'Active-assisted ROM'), ('6-12 wk', 'Strengthen if healing'),
         ('~12 wk', 'Contact sport once united')]
for i, (a, b) in enumerate(steps):
    cx = 1.9 + i * 3.1
    circle(s, cx, 5.4, 1.25, GOLD)
    tb(s, cx - 0.62, 5.15, 1.24, 0.5, a, 15, 'FFFFFF', True, align='c', anchor='m', font='Georgia', check=False)
    tb(s, cx - 1.25, 6.1, 2.5, 0.6, b, 13, TXT, align='c', tag='step')
    if i < 3:
        shape(s, MSO_SHAPE.RIGHT_ARROW, cx + 0.85, 5.25, 0.55, 0.3, DEEP)
tb(s, 0.7, 4.6, 5, 0.35, 'Typical timeline (individualise)', 12, GREY, italic=True, check=False)

# ---------- 12 Evidence ----------
s = content('Evidence: operative versus nonoperative')
stat(s, 1.9, 2.45, 1.5, '15%', 'nonunion after nonoperative care of displaced fractures (Campbell)', fs=24, lab_w=2.9, lab_h=0.9)
stat(s, 5.1, 2.45, 1.5, '24 RCTs', 'network meta-analysis, 2161 patients (Shi 2022)', fs=19, lab_w=2.9, lab_h=0.9)
stat(s, 8.3, 2.45, 1.5, '4 + 10', 'AAOS 2023 guideline: 4 recommendations, 10 options', fs=22, lab_w=2.9, lab_h=0.9)
bullets(s, 0.7, 4.85, 11.9, 2.2, [
    'COTS 2007 RCT||completely displaced midshaft fractures: plating gave earlier function and fewer nonunions and symptomatic malunions than a sling',
    'Network meta-analysis||nonoperative care has more nonunion in markedly displaced or comminuted fractures; plating and nailing have similar low nonunion and function; long-term differences may be small',
    'Risk factors in nonoperative care||complete displacement, shortening above 2 cm, comminution, associated fractures'],
        13.5, TXT, GOLD, DEEP, 5, tag='evid')
rrect(s, 10.7, 1.7, 1.95, 2.0, LIGHT, GOLD, 1.25, 0.06)
tb(s, 10.78, 1.75, 1.8, 1.9, 'Select, do not treat everyone the same', 13, DEEP, True, align='c', anchor='m', font='Georgia', tag='sel')
notes(s, 'Canadian Orthopaedic Trauma Society 2007 JBJS Am. Network MA: Shi et al 2022 Injury PMID 35459544. AAOS CPG summary: Wright and Della Rocca 2023 PMID 37432981. New 2024-2026 meta-analyses should be checked before final recommendation.')

# ---------- 13 Indications ----------
s = content('Indications for surgery')
card(s, 0.7, 1.65, 5.8, 5.2, 'Absolute / urgent', [
    'Open fracture',
    'Skin tenting with impending compromise',
    'Vascular injury needing repair',
    'Progressive neurological deficit',
    'Displaced fracture compressing mediastinal structures (medial)'], 15)
card(s, 6.83, 1.65, 5.8, 5.2, 'Relative (shared decision)', [
    'Complete displacement and shortening above 2 cm',
    'Comminuted or segmental midshaft',
    'Floating shoulder',
    'Polytrauma or need for early weight bearing through arm',
    'High-demand athlete or manual worker',
    'Symptomatic nonunion or malunion',
    'Unstable Neer II and V lateral fractures'], 14.5)

# ---------- 14 Surgical options ----------
s = content('Fixation options')
rows = [['Option', 'Advantages', 'Drawbacks'],
        ['Superior plate', 'Strong in tension; easy exposure', 'Prominent; more hardware removal'],
        ['Anteroinferior plate', 'Less prominent; drill points away from vessels', 'Harder exposure; contouring'],
        ['Intramedullary nail or pin', 'Small incision, less prominence', 'Poor control of comminution and length'],
        ['Distal: locking or hook plate', 'Short fragment fixation', 'Hook: subacromial erosion, removal'],
        ['CC reconstruction or suture button', 'Restores CC suspension', 'Often combined with plate']]
table(s, 0.7, 1.6, 8.3, rows, [2.3, 3.2, 2.8], [0.45] + [0.9] * 5, DEEP, 'FFFFFF', ['FFFFFF', LIGHT], TXT, 12.5, 13)
pic(s, A + 'cl_lcp_series.jpg', 9.3, 1.6, 3.35, 5.3, GOLD, 'Pre-op, post-op, 3 months')

# ---------- 15 Technique ----------
s = content('Plating: technique pearls')
bullets(s, 0.7, 1.6, 6.6, 5.3, [
    'Set-up||beach chair or supine with bump; image intensifier from the opposite side',
    'Incision||along or just below the clavicle; protect supraclavicular nerves',
    'Reduce||clamps to restore length and rotation; lag screw for wedge fragments',
    'Plate||precontoured; at least six cortices on each side of the fracture',
    'Drill safely||soft tissue guard, controlled depth; subclavian vessels and lung lie beneath',
    'Close||myofascial layer over the plate to reduce prominence'],
        15, TXT, GOLD, DEEP, 8, tag='tech')
pic(s, A + 'cl_orif.jpg', 7.6, 1.6, 5.05, 5.25, GOLD, 'Reduction, plate contouring, pre- and post-op films')

# ---------- 16 Rehab ----------
s = content('Postoperative rehabilitation')
ph = [('0-2 wk', 'Sling for comfort; pendulums; hand, wrist, elbow motion'),
      ('2-6 wk', 'Active-assisted motion; elevation limited to about 90 degrees; light daily use'),
      ('6-12 wk', 'Check radiograph; progress to full motion and strengthening'),
      ('>12 wk', 'Return to heavy work and contact sport when united and strong')]
for i, (a, b) in enumerate(ph):
    cx = 2.0 + i * 3.1
    circle(s, cx, 2.6, 1.7, None, GOLD, 1.5)
    circle(s, cx, 2.6, 1.45, GOLD)
    tb(s, cx - 0.7, 2.3, 1.4, 0.6, a, 18, 'FFFFFF', True, align='c', anchor='m', font='Georgia', check=False)
    tb(s, cx - 1.4, 3.65, 2.8, 1.5, b, 13, TXT, align='c', tag='rehab')
    if i < 3:
        shape(s, MSO_SHAPE.RIGHT_ARROW, cx + 1.0, 2.45, 0.6, 0.3, DEEP)
rrect(s, 0.7, 5.35, 11.93, 1.5, LIGHT, GOLD, 1.25, 0.05)
bullets(s, 0.9, 5.45, 11.5, 1.35, [
    'Timelines are typical; follow the operating surgeon protocol and fixation stability.',
    'Hardware removal is considered only for symptoms, after union, with refracture risk counselled.'],
        14, TXT, GOLD, DEEP, 6, tag='rehab2')

# ---------- 17 Lateral surgical ----------
s = content('Lateral third: surgical options')
bullets(s, 0.7, 1.6, 6.6, 5.3, [
    'Who||Neer IIB and V, and displaced IIA; Neer I and III usually nonoperative',
    'Superior locking plate||short fragment fixation with several distal screws',
    'Hook plate||spans the AC joint; plan removal because of subacromial erosion and stiffness',
    'CC ligament reconstruction||suture button or tendon graft, with or without plate',
    'Tension band or wires||historic; migration risk',
    'Evidence||see network meta-analysis of fixation methods for unstable distal fractures (Xu 2022)'],
        14.5, TXT, GOLD, DEEP, 8, tag='lat')
pic(s, A + 'cl_distalplate.jpg', 7.6, 1.6, 5.05, 4.8, GOLD, 'Distal plate with coracoid anchor, healed at 1 year')

# ---------- 18 Complications ----------
s = content('Complications')
rows = [['Complication', 'Notes'],
        ['Nonunion', 'Higher with displacement, comminution, nonoperative care in displaced fractures'],
        ['Malunion', 'Shortening above 2 cm; weakness, scapular dyskinesis, thoracic outlet symptoms'],
        ['Hardware prominence', 'Common reason for removal'],
        ['Infection', 'Superficial or deep; lower with careful soft tissue handling'],
        ['Nerve numbness', 'Supraclavicular branches, anterior chest wall'],
        ['Fixation failure', 'Plate breakage, loss of reduction (see image)'],
        ['Refracture', 'After plate removal; protect for months']]
table(s, 0.7, 1.6, 8.3, rows, [2.2, 6.1], [0.42] + [0.7] * 7, DEEP, 'FFFFFF', ['FFFFFF', LIGHT], TXT, 12.5, 13)
pic(s, A + 'cl_failure.jpg', 9.3, 1.6, 3.35, 5.3, GOLD, 'Plate fracture and revision')

# ---------- 19 Nonunion malunion ----------
s = content('Nonunion and malunion')
pic(s, A + 'cl_nonunion.jpg', 0.7, 1.6, 5.4, 3.4, GOLD, 'Hypertrophic nonunion: CT and plate revision')
pic(s, A + 'cl_malunion.jpg', 0.7, 5.15, 3.0, 1.9, GOLD, 'Malunion with overlap')
bullets(s, 6.4, 1.6, 6.25, 5.3, [
    'Nonunion work-up||symptoms, CT, CRP and ESR, smoking status, exclude infection',
    'Hypertrophic||stable compression plating with lag screw; resect and decorticate',
    'Atrophic||plating plus autograft (iliac crest)',
    'Plate placement||superior or anteroinferior; at least six cortices each side',
    'Malunion||offer corrective osteotomy only if symptomatic, with shortening, dyskinesis or thoracic outlet signs',
    'Prevention||anatomic length and rotation at index surgery; stop smoking'],
        14.5, TXT, GOLD, DEEP, 7, tag='nu')

# ---------- 20 Special situations ----------
s = content('Special situations')
card(s, 0.7, 1.65, 3.85, 5.2, 'Children', [
    'Remodel well; nonoperative in most',
    'Surgery: open, tenting, neurovascular injury, adolescent with floating shoulder',
    'Medial physis: Salter-Harris I or II'], 13.5)
card(s, 4.75, 1.65, 3.85, 5.2, 'Floating shoulder', [
    'Ipsilateral clavicle plus glenoid neck or scapula fracture',
    'Fixing a displaced clavicle may help scapular alignment',
    'Assess glenoid displacement on CT'], 13.5)
card(s, 8.8, 1.65, 3.83, 5.2, 'Polytrauma and others', [
    'Early weight bearing through the arm favours fixation',
    'Open fractures: debride and fix',
    'Elderly: osteoporotic, lower demand, accept nonoperative more often'], 13.5)

# ---------- 21 Algorithm ----------
s = content('Decision pathway')
nodes = [('1', 'Red flags?', 'Open, skin threat, vascular or neuro deficit: surgery urgently'),
         ('2', 'Which third?', 'Medial: CT. Lateral: Neer type. Midshaft: Robinson'),
         ('3', 'How displaced?', 'Complete displacement, shortening above 2 cm, comminution: consider fixation'),
         ('4', 'Patient factors', 'Age, demand, dominance, smoking, job: shared decision')]
for i, (n, a, b) in enumerate(nodes):
    cx = 1.9 + i * 3.1
    circle(s, cx, 2.5, 1.6, None, GOLD, 1.5)
    circle(s, cx, 2.5, 1.35, GOLD)
    tb(s, cx - 0.6, 2.15, 1.2, 0.7, n, 32, 'FFFFFF', True, align='c', anchor='m', font='Georgia', check=False)
    tb(s, cx - 1.4, 3.5, 2.8, 0.4, a, 16, DEEP, True, align='c', font='Georgia')
    tb(s, cx - 1.4, 3.95, 2.8, 1.3, b, 13, TXT, align='c', tag='alg')
    if i < 3:
        shape(s, MSO_SHAPE.RIGHT_ARROW, cx + 1.0, 2.35, 0.6, 0.3, DEEP)
rrect(s, 0.7, 5.5, 5.8, 1.3, LIGHT, GOLD, 1.25, 0.06)
tb(s, 0.85, 5.55, 5.5, 1.2, 'Sling, early motion, radiographs at about 6 weeks. Surgery if symptomatic nonunion or malunion.', 14, TXT, anchor='m', tag='algA')
rrect(s, 6.83, 5.5, 5.8, 1.3, LIGHT, GOLD, 1.25, 0.06)
tb(s, 6.98, 5.55, 5.5, 1.2, 'Plate or nail with a defined rehab plan; counsel on hardware prominence and numbness.', 14, TXT, anchor='m', tag='algB')

# ---------- 22 Viva pearls ----------
s = content('Viva pearls')
pearls = ['80-85% of clavicle fractures are midshaft', 'Medial fragment goes up (SCM); lateral goes down and in (arm weight)',
          'Neer II = fracture medial to CC ligaments, unstable', 'Shortening above 2 cm and complete displacement raise nonunion risk',
          'Plate and nail both lower nonunion than sling in displaced fractures', 'Always check chest, scapula and neurovascular status']
for i, p in enumerate(pearls):
    cx = 1.3 + (i % 2) * 6.2
    cy = 2.2 + (i // 2) * 1.6
    circle(s, cx, cy, 0.9, GOLD)
    tb(s, cx - 0.4, cy - 0.3, 0.8, 0.6, str(i + 1), 24, 'FFFFFF', True, align='c', anchor='m', font='Georgia', check=False)
    tb(s, cx + 0.65, cy - 0.5, 4.8, 1.0, p, 15, TXT, True, anchor='m', tag='pearl')

# ---------- 23-24 References ----------
refs1 = [
    'Allman, F.L. (1967) \'Fractures and ligamentous injuries of the clavicle and its articulation\', Journal of Bone and Joint Surgery (American Volume), 49(4), pp. 774-784.',
    'Campbell\'s Operative Orthopaedics (2026) 15th edn. Philadelphia: Elsevier.',
    'Canadian Orthopaedic Trauma Society (2007) \'Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures: a multicenter, randomized clinical trial\', Journal of Bone and Joint Surgery (American Volume), 89(1), pp. 1-10.',
    'Kihlstrom, C., Moller, M., Lonn, K. and Wolf, O. (2017) \'Clavicle fractures: epidemiology, classification and treatment of 2422 fractures in the Swedish Fracture Register; an observational study\', BMC Musculoskeletal Disorders, 18(1), p. 82.',
    'Neer, C.S. (1968) \'Fractures of the distal third of the clavicle\', Clinical Orthopaedics and Related Research, 58, pp. 43-50.',
    'Robinson, C.M. (1998) \'Fractures of the clavicle in the adult: epidemiology and classification\', Journal of Bone and Joint Surgery (British Volume), 80(3), pp. 476-484.']
refs2 = [
    'Shi, F., Hu, H., Tian, M., Fang, X. and Li, X. (2022) \'Comparison of 3 treatment methods for midshaft clavicle fractures: a systematic review and network meta-analysis of randomized clinical trials\', Injury. doi:10.1016/j.injury.2022.04.005 (PMID 35459544).',
    'Woltz, S. and McKee, M.D. (2025) \'Clavicle fractures\', in Rockwood and Green\'s Fractures in Adults. 10th edn. Philadelphia: Wolters Kluwer.',
    'Wright, M. and Della Rocca, G.J. (2023) \'American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures\', Journal of the American Academy of Orthopaedic Surgeons. doi:10.5435/JAAOS-D-23-00472 (PMID 37432981).',
    'Xu, Y., Guo, X., Peng, H. et al. (2022) \'Different internal fixation methods for unstable distal clavicle fractures in adults: a systematic review and network meta-analysis\', Journal of Orthopaedic Surgery and Research. doi:10.1186/s13018-021-02904-6 (PMID 35073954).',
    'Radiographs and clinical figures: pmc_clinical_VQA, open-access PubMed Central figures and captions. Hugging Face. Available at: https://huggingface.co (Accessed: 8 November 2026). Epidemiology chart reproduced via Rockwood and Green\'s (Woltz and McKee, 2025) from Kihlstrom et al. (2017), CC BY 4.0.']
for ttl, refs in [('References (1 of 2)', refs1), ('References (2 of 2)', refs2)]:
    s = content(ttl)
    bullets(s, 0.7, 1.6, 11.9, 5.4, refs, 12.5, TXT, GOLD, DEEP, 8, tag=ttl)

check_bounds(prs, 'clav')
prs.save('/tmp/workspace/ortho-decks/Clavicle_Fractures_Gold.pptx')
print('\n'.join(WARN) or 'no warnings', len(prs.slides))

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/ortho-decks/deck1.py'

import sys
sys.path.insert(0, '/tmp/workspace/ortho-decks')
from lib import *

A = '/tmp/workspace/ortho-decks/assets/'
RED, DEEP, ROSE, BG, GOLD, TXT, GREY = '8B0A1F', '5C0615', 'F6E3E5', 'FBF6F4', 'C9A24B', '2B1A1C', '7A6A6C'
SHORT = 'Genu Varum and Genu Valgum  |  Orthopaedic Resident Teaching'
HF = 'Cambria'
prs = new_prs()
pg = [1]


def content(title, size=28):
    s = blank(prs, BG)
    pg[0] += 1
    rect(s, 0, 0, 13.333, 1.15, RED)
    rect(s, 0, 1.15, 13.333, 0.06, GOLD)
    tb(s, 0.7, 0.15, 11.0, 0.85, title, size, 'FFFFFF', True, anchor='m', font=HF, tag='title:' + title)
    tb(s, 12.0, 0.3, 0.8, 0.55, str(pg[0]), 20, 'F0C9CE', True, align='r', anchor='m', font=HF, check=False)
    rect(s, 0, 7.12, 13.333, 0.38, DEEP)
    tb(s, 0.7, 7.15, 9, 0.3, SHORT, 10, 'E9C9CD', check=False)
    return s


def card(s, x, y, w, h, head, items, size=14):
    rect(s, x, y, w, h, 'FFFFFF', 'E3C5C9', 1.0)
    rect(s, x, y, w, 0.09, RED)
    tb(s, x + 0.15, y + 0.15, w - 0.3, 0.45, head, 16, RED, True, font=HF, anchor='m', tag='cardhead')
    bullets(s, x + 0.15, y + 0.7, w - 0.3, h - 0.8, items, size, TXT, RED, RED, 5, bu='\u25A0', tag='card:' + head)


def stat(s, x, y, w, h, big, label, fs=26, ls=12):
    rect(s, x, y, w, h, RED)
    rect(s, x, y + h - 0.07, w, 0.07, GOLD)
    tb(s, x + 0.1, y + 0.1, w - 0.2, h * 0.5, big, fs, 'FFFFFF', True, align='c', anchor='m', font=HF, check=False)
    tb(s, x + 0.12, y + h * 0.52, w - 0.24, h * 0.42, label, ls, 'F8E6E8', align='c', anchor='m', tag='stat:' + big)


def vtable(s, x, y, w, rows, colw, rowh, size=12.5):
    return table(s, x, y, w, rows, colw, rowh, RED, 'FFFFFF', ['FFFFFF', ROSE], TXT, size, 13.5, font='Calibri')


# 1 Title
s = blank(prs, DEEP)
rect(s, 0, 0, 13.333, 0.25, GOLD)
rect(s, 0, 7.25, 13.333, 0.25, GOLD)
tb(s, 0.8, 1.0, 6.0, 0.4, 'ORTHOPAEDIC RESIDENT TEACHING SERIES', 14, GOLD, True)
tb(s, 0.8, 1.6, 6.3, 2.4, ['Genu Varum', 'and Genu Valgum'], 46, 'FFFFFF', True, font=HF, tag='t1')
rect(s, 0.85, 4.2, 1.8, 0.05, GOLD)
tb(s, 0.8, 4.4, 5.9, 1.4, 'Physiology, assessment, Blount disease, metabolic causes and guided growth versus osteotomy', 19,
   'F0D6D9', tag='sub')
tb(s, 0.8, 6.4, 6, 0.5, 'Sources: Miller\'s Review 9th ed, Campbell 15th ed, Bailey and Love 28th ed, PubMed 2019-2026', 12,
   'D9AEB4', check=False)
pic(s, A + 'gv_valgum_mad.jpg', 7.3, 0.7, 5.4, 3.2, GOLD)
pic(s, A + 'gv_gg_seq.jpg', 7.3, 4.2, 5.4, 2.7, GOLD)
notes(s, 'Top: bilateral genu valgum with lateral mechanical axis deviation. Bottom: guided growth correction sequence.')

# 2 Objectives
s = content('Learning objectives')
objs = ['Define varus and valgus and use the key alignment angles', 'Separate physiologic from pathologic deformity',
        'Work up the child: history, exam, long-leg films, labs', 'Diagnose and stage Blount disease',
        'Recognise metabolic and post-traumatic causes', 'Choose guided growth, osteotomy or gradual correction']
for i, o in enumerate(objs):
    x = 0.7 + (i % 3) * 4.05
    y = 1.65 + (i // 3) * 2.65
    rect(s, x, y, 3.85, 2.4, 'FFFFFF', 'E3C5C9', 1)
    rect(s, x, y, 3.85, 0.09, RED)
    tb(s, x + 0.2, y + 0.3, 1.0, 0.8, str(i + 1), 40, RED, True, font=HF, check=False)
    tb(s, x + 0.2, y + 1.15, 3.45, 1.1, o, 15, TXT, True, tag='obj')

# 3 Definitions
s = content('Terms and normal alignment values')
rows = [['Term / angle', 'Normal', 'What it tells you'],
        ['Varus', 'Distal segment toward midline', 'Knee apex lateral: bowlegs'],
        ['Valgus', 'Distal segment away from midline', 'Knee apex medial: knock knees'],
        ['Mechanical axis deviation (MAD)', 'Passes just medial to knee centre (about 8 mm +/- 7 mm)', 'Whole-limb alignment'],
        ['mLDFA (mechanical lateral distal femoral angle)', '85 to 90 degrees (mean about 87.5)', 'Below 85: femoral valgus; above 90: femoral varus'],
        ['MPTA (medial proximal tibial angle)', '85 to 90 degrees (mean about 87)', 'Below 85: tibial varus; above 90: tibial valgus'],
        ['JLCA (joint line convergence angle)', 'About 2 degrees or less', 'Ligamentous or cartilage contribution'],
        ['Adult anatomic tibiofemoral angle', 'About 5 to 7 degrees valgus', 'Clinical and plain film check']]
vtable(s, 0.7, 1.55, 11.93, rows, [3.6, 4.2, 4.1], [0.42] + [0.66] * 7, 12.5)
tb(s, 0.7, 6.65, 11.9, 0.4, 'Values after Paley (2002); verify against your institutional norms.', 11, GREY, italic=True, check=False)

# 4 Normal development
s = content('Normal development of limb alignment')
pic(s, A + 'gv_graph.png', 0.7, 1.55, 6.6, 4.3, RED, 'Tibiofemoral angle versus age (Bailey and Love, Fig 44.3)')
bullets(s, 7.6, 1.55, 5.05, 5.4, [
    'Birth||all children start with bowlegs, often with internal tibial torsion',
    'About 18 months||bowing begins to improve; corrected by age 3 to 4 years',
    'Age 3 to 4||peak valgus; up to 15 degrees is common from 2 to 6 years',
    'By age 7||settles near the adult value of about 7 degrees valgus',
    'Implication||most deformity under age 6 is physiologic and needs observation only'],
        14.5, TXT, RED, RED, 8, bu='\u25A0', tag='dev')

# 5 Physio image
s = content('Physiologic genu varum: the expected course')
pic(s, A + 'gv_physio.png', 0.7, 1.5, 11.93, 4.35, RED, 'Newborn to 4 to 6 years (Miller\'s Review, Fig 3.15)')
bullets(s, 0.7, 5.95, 11.93, 1.1, [
    'Symmetric, mild, proportionate to age; femur and tibia bow smoothly; no pain; normal height and bloods',
    'Review at 6 to 12 month intervals; refer if progressive, asymmetric, painful, or varus persists beyond 2 to 3 years'],
        14, TXT, RED, RED, 4, bu='\u25A0', tag='physio')

# 6 Physiologic vs pathologic
s = content('Physiologic versus pathologic')
rows = [['Feature', 'Physiologic', 'Pathologic'],
        ['Age', 'Varus under 2 years; valgus 2 to 6 years', 'Varus beyond 2 to 3 years; valgus beyond 7 to 8 years'],
        ['Symmetry', 'Symmetric, bilateral', 'Often asymmetric or unilateral'],
        ['Severity and course', 'Mild; improves with growth', 'Marked; static or worsening'],
        ['Stature and bloods', 'Normal height; normal Ca, PO4, ALP', 'Short or disproportionate; abnormal metabolic profile'],
        ['Radiograph (varus)', 'Smooth bowing of femur and tibia; MDA below 11 degrees', 'Focal proximal tibial angulation, beaking; MDA above 16 degrees'],
        ['Valgus clue', 'Within 15 degrees; intermalleolar gap settles', 'Over 15 degrees or gap above 10 cm in a child over 10 years']]
vtable(s, 0.7, 1.55, 11.93, rows, [2.4, 4.7, 4.8], [0.42] + [0.8] * 6, 13)
tb(s, 0.7, 6.65, 11.9, 0.4, 'MDA = metaphyseal-diaphyseal angle (Levine and Drennan, 1982). Thresholds: Miller\'s Review.', 11, GREY, italic=True, check=False)

# 7 Clinical assessment
s = content('Clinical assessment')
card(s, 0.7, 1.55, 3.85, 5.4, 'History', [
    'Age at onset, progression',
    'Unilateral or bilateral',
    'Age walking began; obesity',
    'Diet, sun exposure, family history of rickets or short stature',
    'Trauma or infection near the knee',
    'Pain, function, sport'], 13.5)
card(s, 4.75, 1.55, 3.85, 5.4, 'Examination', [
    'Stand barefoot, patellae forward',
    'Intercondylar or intermalleolar distance',
    'Lateral thrust in gait (varus)',
    'Rotational profile: tibial torsion',
    'Limb length, BMI, ligament laxity',
    'Rachitic signs: wrist widening, rosary'], 13.5)
card(s, 8.8, 1.55, 3.83, 5.4, 'Screen for pathology', [
    'Height and arm span for dysplasia',
    'Bilateral valgus: think renal or metabolic',
    'Unilateral: physeal injury, infection, tumour',
    'Early walker, heavy, tibial angulation: Blount',
    'Always inspect spine and hips'], 13.5)

# 8 Imaging
s = content('Imaging and investigations')
bullets(s, 0.7, 1.55, 6.8, 5.4, [
    'Standing long-leg AP||patellae forward, both limbs on one film; measure MAD, mLDFA, MPTA, JLCA',
    'Tibia vara||metaphyseal-diaphyseal angle and Langenskiold stage',
    'Lateral knee||procurvatum, physeal contour',
    'Bone age||plan growth modulation timing',
    'CT or MRI||suspected physeal bar or plateau depression (late Blount)',
    'Labs||calcium, phosphate, ALP, PTH, 25-OH vitamin D, creatinine; FGF23 or genetics if hypophosphataemia'],
        14.5, TXT, RED, RED, 8, bu='\u25A0', tag='imaging')
pic(s, A + 'gv_valgum_mad.jpg', 7.8, 1.55, 4.85, 3.4, RED, 'Bilateral valgus with lateral MAD')
rect(s, 7.8, 5.2, 4.85, 1.6, ROSE, RED, 1)
tb(s, 7.95, 5.25, 4.55, 1.5, 'Always hold the limb in neutral rotation. A rotated film gives a false varus or valgus reading.', 13.5, TXT, True, anchor='m', tag='imgnote')

# 9 Varus differential
s = content('Genu varum: causes')
causes = [('Physiologic', 'Under 2 to 3 years, symmetric, resolves'),
          ('Blount disease', 'Infantile or adolescent tibia vara; proximal tibial physis'),
          ('Metabolic', 'Nutritional rickets, hypophosphataemic rickets, renal osteodystrophy'),
          ('Skeletal dysplasia', 'Achondroplasia, metaphyseal chondrodysplasia, osteogenesis imperfecta'),
          ('Post-traumatic or infective', 'Physeal arrest or malunion; the commonest pathological cause with rickets and dysplasia (Bailey and Love)'),
          ('Focal lesions', 'Focal fibrocartilaginous dysplasia, osteochondroma, Ollier disease')]
for i, (a, b) in enumerate(causes):
    x = 0.7 + (i % 3) * 4.05
    y = 1.6 + (i // 3) * 2.7
    rect(s, x, y, 3.85, 2.5, 'FFFFFF', 'E3C5C9', 1)
    rect(s, x, y, 3.85, 0.09, RED)
    tb(s, x + 0.2, y + 0.25, 3.45, 0.5, a, 17, RED, True, font=HF, tag='cause')
    tb(s, x + 0.2, y + 0.85, 3.45, 1.5, b, 14, TXT, tag='cause2')

# 10 Blount types
s = content('Blount disease: pathogenesis and types')
bullets(s, 0.7, 1.55, 5.6, 5.4, [
    'Definition||acquired disorder of the proximal tibial physis (Campbell)',
    'Deformity||varus, internal tibial torsion and procurvatum',
    'Cause||unknown; altered enchondral ossification under excess mechanical stress',
    'Weight bearing needed||does not occur in nonambulant children',
    'Risks||early walking, obesity, vitamin D deficiency; more common in Black children'],
        14, TXT, RED, RED, 8, bu='\u25A0', tag='blount')
rows = [['Feature', 'Infantile', 'Adolescent'],
        ['Onset', 'Under 3 years', 'Over 10 years'],
        ['Laterality', 'Often bilateral', 'Often unilateral'],
        ['Severity', 'Can be severe; medial plateau depression', 'Milder'],
        ['Radiograph', 'Metaphyseal beaking, MDA above 16', 'Widened medial physis; no beaking'],
        ['Typical child', 'Heavy early walker', 'Obese adolescent']]
vtable(s, 6.6, 1.55, 6.03, rows, [1.3, 2.4, 2.3], [0.42] + [0.85] * 5, 12.5)
tb(s, 6.6, 6.35, 6.0, 0.5, 'A juvenile form (ages 4 to 10) is also described.', 11.5, GREY, italic=True, check=False)

# 11 Blount radiology
s = content('Blount disease: radiographic assessment')
pic(s, A + 'gv_mda.png', 0.7, 1.5, 3.4, 5.5, RED, 'TFA 32 vs MDA 20 degrees (Miller\'s, Fig 3.16)')
pic(s, A + 'gv_itv.jpg', 4.3, 1.5, 3.4, 5.5, RED, 'Bilateral infantile tibia vara, MDA 22 and 16')
bullets(s, 7.95, 1.55, 4.7, 5.4, [
    'MDA||angle between a line across the two metaphyseal beaks and the line perpendicular to the tibial shaft; above 16 degrees is abnormal',
    'Langenskiold I to VI||I irregular medial metaphysis, through to VI bony bridge across the medial physis',
    'Beyond MDA||medial plateau depression, physeal bar, joint line obliquity',
    'Do not rely on the tibiofemoral angle alone||it is affected by rotation and femoral bowing'],
        13.5, TXT, RED, RED, 8, bu='\u25A0', tag='blountrad')

# 12 Late disease images
s = content('Blount disease: late presentations and surgery')
bullets(s, 0.7, 1.55, 4.3, 5.4, [
    'Failed early surgery||medial physeal bar with recurrence and limb length discrepancy',
    'Late onset||multilevel deformity: distal femur varus, proximal tibia varus, compensatory distal tibial valgus',
    'Plateau depression||may need intra-epiphyseal osteotomy to elevate the medial plateau',
    'Plan with full-length films and mechanical axis'],
        13.5, TXT, RED, RED, 8, bu='\u25A0', tag='late')
pic(s, A + 'gv_blount7.jpg', 5.2, 1.5, 2.55, 5.5, RED, 'Age 7: failed osteotomy')
pic(s, A + 'gv_lotv.jpg', 7.95, 1.5, 2.1, 5.5, RED, 'Age 16: late-onset')
pic(s, A + 'gv_postosteo.jpg', 10.25, 1.5, 2.4, 5.5, RED, '1 year after osteotomy')

# 13 Blount management
s = content('Blount disease: management')
rows = [['Stage / patient', 'Option', 'Comment'],
        ['Langenskiold I-II, under 3 years', 'Bracing', 'Better if unilateral and nonobese; compliance is difficult'],
        ['Stage II over 3 years, stage III', 'Proximal tibial and fibular valgus osteotomy', 'Overcorrect because medial physeal growth stays abnormal'],
        ['Early disease or adolescent with growth left', 'Lateral hemiepiphysiodesis (guided growth)', 'Larger plates; implant failure is more frequent'],
        ['Stage IV-VI', 'Physeal bar resection, epiphysiolysis, plateau elevation', 'Complex; often staged or combined'],
        ['Limb length discrepancy', 'Ilizarov or hexapod correction and lengthening', 'Acute versus gradual: see Gilbody 2009'],
        ['Physis closed, severe', 'Osteotomy; later arthroplasty if arthritic', 'Blount-like TKA reviewed 2025']]
vtable(s, 0.7, 1.55, 11.93, rows, [3.3, 4.4, 4.2], [0.42] + [0.78] * 6, 12.5)
tb(s, 0.7, 6.7, 11.9, 0.35, 'Source: Miller\'s Review of Orthopaedics; Campbell\'s Operative Orthopaedics.', 11, GREY, italic=True, check=False)

# 14 Metabolic
s = content('Metabolic causes and rickets')
pic(s, A + 'gv_rickets.jpg', 0.7, 1.55, 5.3, 4.5, RED, 'Genu valgum with metabolic bone disease: 38 and 26 degrees')
card(s, 6.3, 1.55, 6.33, 1.65, 'Nutritional rickets', ['Vitamin D and calcium repletion first; many deformities improve'], 13.5)
card(s, 6.3, 3.35, 6.33, 1.65, 'Hypophosphataemic rickets (XLH)', ['Phosphate and active vitamin D, or burosumab; surgery after metabolic control'], 13.5)
card(s, 6.3, 5.15, 6.33, 1.75, 'Renal osteodystrophy', ['Most common cause of bilateral valgus (Miller\'s Review); treat renal and mineral disease'], 13.5)
tb(s, 0.7, 6.2, 5.3, 0.7, 'Deformity surgery is more reliable once ALP is falling and healing is seen on films.', 12.5, TXT, italic=True, tag='metnote')

# 15 Valgum aetiology
s = content('Genu valgum: causes and natural history')
stat(s, 0.7, 1.55, 2.9, 1.5, '3 to 4 yr', 'peak physiologic valgus', 28)
stat(s, 3.8, 1.55, 2.9, 1.5, 'up to 15\u00B0', 'common between 2 and 6 years', 28)
stat(s, 6.9, 1.55, 2.9, 1.5, '7\u00B0', 'adult valgus reached by about age 7', 28)
stat(s, 10.0, 1.55, 2.63, 1.5, '>10 cm', 'intermalleolar gap: consider surgery if older than 10', 28)
bullets(s, 0.7, 3.35, 11.93, 3.7, [
    'Physiologic||no treatment needed',
    'Renal osteodystrophy and rickets||commonest causes of bilateral pathologic valgus',
    'Post-traumatic||including proximal tibial metaphyseal fracture overgrowth (Cozen)',
    'Tumour and dysplasia||osteochondromas, Ollier disease, Morquio, spondyloepiphyseal dysplasia',
    'Infection||may stimulate asymmetric proximal tibial growth',
    'Obesity||increases load and may worsen deformity'],
        14.5, TXT, RED, RED, 7, bu='\u25A0', tag='valgcause')

# 16 Consequences
s = content('Why correct: natural history and joint effects')
card(s, 0.7, 1.55, 5.8, 3.4, 'Valgus', [
    'Lateral compartment overload',
    'Patellar maltracking and instability',
    'Distal femoral osteotomy improves recurrent patellar instability with genu valgum (Moran 2024)'], 14)
card(s, 6.83, 1.55, 5.8, 3.4, 'Varus', [
    'Medial compartment overload and early arthritis',
    'Lateral thrust and lateral ligament attenuation',
    'Unilateral cases bring limb length discrepancy'], 14)
rect(s, 0.7, 5.2, 11.93, 1.65, ROSE, RED, 1)
bullets(s, 0.9, 5.3, 11.5, 1.5, [
    'Evidence is limited for the benefit of correcting mild idiopathic deformity; treat based on severity, symptoms and progression.',
    'Sport and genu varum in youth: systematic review 2026 (Isin et al.); assess before attributing deformity to training.'],
        13.5, TXT, RED, RED, 6, bu='\u25A0', tag='conseq')

# 17 Valgum treatment
s = content('Genu valgum: treatment')
bullets(s, 0.7, 1.55, 6.3, 5.4, [
    'Physiologic||observe; shoes, braces and exercises do not change the course',
    'Pathologic||treat the cause; conservative care is ineffective (Miller\'s Review)',
    'Surgical trigger||child over 10 years with more than 10 cm between the malleoli or more than 15 degrees valgus',
    'Growth left||medial hemiepiphysiodesis of distal femur and/or proximal tibia with a tension-band plate',
    'Plate versus staple||compared in a 2019 systematic review (Knapik)',
    'Timing||isolated medial femoral hemiepiphysiodesis: indications and timing reviewed 2023 (Artioli)',
    'Physis closed||femoral or tibial osteotomy at the apex'],
        14, TXT, RED, RED, 7, bu='\u25A0', tag='valgtx')
pic(s, A + 'gv_gg_valgum.jpg', 7.3, 1.55, 5.35, 3.4, RED, 'Guided growth for genu valgum over about 8 months')
pic(s, A + 'gv_eightplate.jpg', 7.3, 5.05, 5.35, 1.95, RED, 'Proximal medial tibial eight-plate steps')

# 18 Guided growth principles
s = content('Guided growth: principles')
pic(s, A + 'gv_gg_seq.jpg', 0.7, 1.55, 5.7, 3.1, RED, 'Progressive correction of bilateral genu valgum')
bullets(s, 0.7, 4.85, 5.7, 2.2, [
    'Tether one side of the physis; the other side keeps growing',
    'Place at the level of deformity: femur if mLDFA is abnormal, tibia if MPTA is abnormal'],
        13.5, TXT, RED, RED, 5, bu='\u25A0', tag='ggp1')
card(s, 6.7, 1.55, 5.93, 2.55, 'Planning', [
    'Needs enough growth: bone age and remaining years',
    'Distal femur gives about 70% of femoral growth; proximal tibia about 55 to 60% of tibial growth',
    'Review every 3 to 4 months'], 13)
card(s, 6.7, 4.25, 5.93, 2.7, 'Pitfalls', [
    'Remove at neutral alignment; watch for rebound after removal',
    'Overcorrection, implant breakage, physeal arrest, infection',
    'Obesity and Blount disease: higher failure, use stronger implants'], 13)

# 19 Options table
s = content('Surgical options compared')
rows = [['Option', 'Best for', 'Advantages', 'Drawbacks'],
        ['Guided growth', 'Skeletally immature, idiopathic or metabolic', 'Minimal incision, reversible', 'Needs growth, follow-up; rebound'],
        ['Acute osteotomy', 'Near or at maturity; severe or multiplanar', 'Immediate correction', 'Neurovascular and compartment risk; fixation'],
        ['Gradual correction (frame)', 'Large deformity, LLD, Blount', 'Fine control, lengthening', 'Pin sites, burden, duration'],
        ['Physeal bar resection / plateau elevation', 'Late Blount stage IV-VI', 'Restores growth or joint line', 'Technically demanding; recurrence'],
        ['Adults: HTO or DFO', 'Unicompartmental overload, young active', 'Preserves the joint', 'Hardware; slower return']]
vtable(s, 0.7, 1.55, 11.93, rows, [2.8, 3.2, 2.9, 3.0], [0.45] + [0.9] * 5, 12.5)
tb(s, 0.7, 6.65, 11.9, 0.4, 'HTO high tibial osteotomy; DFO distal femoral osteotomy; LLD limb length discrepancy.', 11, GREY, italic=True, check=False)

# 20 Planning principles
s = content('Deformity planning principles')
card(s, 0.7, 1.55, 2.85, 5.4, 'Where?', [
    'Use mLDFA and MPTA to find the bone',
    'Apex = CORA (Paley)',
    'Check JLCA for soft tissue part'], 13)
card(s, 3.7, 1.55, 2.85, 5.4, 'How much?', [
    'Aim MAD back through knee centre',
    'Overcorrect in Blount',
    'Joint line should stay near horizontal'], 13)
card(s, 6.7, 1.55, 2.85, 5.4, 'How?', [
    'Osteotomy at the CORA avoids translation',
    'If one cut makes the joint line oblique (MPTA above about 95), consider double-level',
    'Plan frame or plate fixation'], 13)
card(s, 9.7, 1.55, 2.93, 5.4, 'Stay safe', [
    'Peroneal nerve stretch with acute varus correction',
    'Compartment syndrome after proximal tibial osteotomy',
    'Check rotation, not only coronal plane'], 13)

# 21 Algorithm
s = content('Approach to the bowlegged or knock-kneed child')
steps = ['Age and pattern', 'Physiologic?', 'Cause work-up', 'Severity and growth', 'Treat']
txts = ['Onset, laterality, family history', 'Symmetric, mild, age-appropriate: observe', 'Long-leg film, MDA, labs, bone age',
        'Angle, MAD, remaining growth', 'Medical, guided growth, osteotomy or frame']
for i, (a, b) in enumerate(zip(steps, txts)):
    x = 0.7 + i * 2.4
    sh = shape(s, MSO_SHAPE.PENTAGON if i == 0 else MSO_SHAPE.CHEVRON, x, 1.7, 2.55, 1.2, RED if i % 2 == 0 else DEEP)
    tb(s, x + 0.45, 1.85, 1.65, 0.9, a, 14, 'FFFFFF', True, align='c', anchor='m', font=HF, tag='step')
    tb(s, x + 0.1, 3.05, 2.2, 1.3, b, 12.5, TXT, align='c', tag='steptxt')
card(s, 0.7, 4.5, 3.85, 2.4, 'Observe', ['Physiologic pattern', 'Review every 6 to 12 months'], 13.5)
card(s, 4.75, 4.5, 3.85, 2.4, 'Treat the cause', ['Rickets, renal, infection, tumour', 'Brace for Blount under 3 years'], 13.5)
card(s, 8.8, 4.5, 3.83, 2.4, 'Correct the deformity', ['Guided growth if growth remains', 'Osteotomy or frame if not'], 13.5)

# 22 Recent evidence
s = content('Recent and key evidence (PubMed)')
rows = [['Paper', 'Focus'],
        ['Artioli et al., The Knee 2023 (PMID 36410251)', 'Indications and timing of medial femoral hemiepiphysiodesis for idiopathic valgum'],
        ['Knapik et al., Orthopedics 2019 (PMID 31355901)', 'Staples versus tension-band plating for idiopathic genu valgum'],
        ['Moran et al., J ISAKOS 2024 (PMID 39260775)', 'Distal femoral osteotomy for patellar instability with genu valgum'],
        ['Arias Perez et al., Musculoskelet Surg 2025 (PMID 39890771)', 'MPFL reconstruction plus varus osteotomy in valgum and recurrent dislocation'],
        ['Isin et al., Br Med Bull 2026 (PMID 42830708)', 'Sports participation and genu varum in youth'],
        ['Gilbody et al., J Pediatr Orthop 2009 (PMID 19352233)', 'Acute versus gradual correction of idiopathic tibia vara'],
        ['Banwarie et al., J Pediatr Orthop B 2020 (PMID 31651748)', 'Possible aetiologies of Blount disease']]
vtable(s, 0.7, 1.55, 11.93, rows, [5.0, 6.9], [0.42] + [0.68] * 7, 12.5)
tb(s, 0.7, 6.65, 11.9, 0.4, 'Read the full text before changing practice; this slide lists topics found on a PubMed search, not conclusions.', 11, GREY, italic=True, check=False)

# 23 Pearls
s = content('Viva pearls')
pearls = ['Bowlegs at birth, straight by 2 to 3 years, peak knock knees at 3 to 4, adult valgus about 7 degrees',
          'MDA above 16 degrees suggests Blount disease; Langenskiold stages I to VI',
          'Bilateral valgus beyond the physiologic age: think renal osteodystrophy or rickets',
          'Blount: brace under 3 years early; osteotomy overcorrects; plates fail more in the obese',
          'Place guided growth at the level of deformity and remove at neutral to avoid rebound',
          'Always use a standing long-leg film with patellae forward']
for i, p in enumerate(pearls):
    x = 0.7 + (i % 2) * 6.05
    y = 1.6 + (i // 2) * 1.8
    rect(s, x, y, 5.88, 1.6, 'FFFFFF', 'E3C5C9', 1)
    rect(s, x, y, 0.09, 1.6, RED)
    tb(s, x + 0.25, y + 0.1, 0.7, 1.4, str(i + 1), 30, RED, True, anchor='m', font=HF, check=False)
    tb(s, x + 0.95, y + 0.1, 4.8, 1.4, p, 14, TXT, True, anchor='m', tag='pearl')

# References
refs1 = [
    'Arias Perez, R.D., Jaramillo Quiceno, G.A., Sarmiento Riveros, P.A. et al. (2025) \'The efficacy of medial patellofemoral ligament reconstruction combined with distal femoral varus osteotomy in recurrent patellar dislocation and genu valgum\', Musculoskeletal Surgery. doi:10.1007/s12306-024-00878-2.',
    'Artioli, E., Mazzotti, A., Ramacci, V. et al. (2023) \'Indications and timing in isolated medial femoral hemiepiphysiodesis for idiopathic genu valgum: a systematic review\', The Knee. doi:10.1016/j.knee.2022.11.009.',
    'Bailey and Love\'s Short Practice of Surgery (2023) 28th edn. Boca Raton: CRC Press.',
    'Banwarie, R.R., Hollman, F., Meijs, N. et al. (2020) \'Insight into the possible aetiologies of Blount\'s disease: a systematic review of the literature\', Journal of Pediatric Orthopaedics Part B. doi:10.1097/BPB.0000000000000677.',
    'Campbell\'s Operative Orthopaedics (2026) 15th edn. Philadelphia: Elsevier.',
    'Gilbody, J., Thomas, G., Ho, K. et al. (2009) \'Acute versus gradual correction of idiopathic tibia vara in children: a systematic review\', Journal of Pediatric Orthopaedics. doi:10.1097/BPO.0b013e31819849aa.']
refs2 = [
    'Isin, A., Akdag, E., Demirkiran, B. et al. (2026) \'Impact of sports participation on genu varum among youth: a systematic review\', British Medical Bulletin. doi:10.1093/bmb/ldag033.',
    'Knapik, D.M., Buschbach, J., Sabharwal, S. et al. (2019) \'Hemiepiphysiodesis for idiopathic genu valgum using physeal staples versus tension-band plating: a systematic review\', Orthopedics. doi:10.3928/01477447-20190723-04.',
    'Levine, A.M. and Drennan, J.C. (1982) \'Physiological bowing and tibia vara: the metaphyseal-diaphyseal angle in the measurement of bowleg deformities\', Journal of Bone and Joint Surgery (American Volume), 64(8), pp. 1158-1163.',
    'Miller\'s Review of Orthopaedics (2025) 9th edn. Philadelphia: Elsevier.',
    'Moran, T.E., Driskill, E.K., Goodloe, J.B. et al. (2024) \'Distal femoral osteotomies improves recurrent patellar instability in patients with genu valgum: a systematic review\', Journal of ISAKOS. doi:10.1016/j.jisako.2024.100318.',
    'Paley, D. (2002) Principles of Deformity Correction. Berlin: Springer.',
    'Figures: radiographs and clinical images from pmc_clinical_VQA, open-access PubMed Central figures and captions. Hugging Face. Available at: https://huggingface.co (Accessed: 8 November 2026). Physiologic course and MDA figures from Miller\'s Review (Figs 3.15, 3.16); tibiofemoral angle graph from Bailey and Love (Fig 44.3).']
for ttl, refs in [('References (1 of 2)', refs1), ('References (2 of 2)', refs2)]:
    s = content(ttl)
    bullets(s, 0.7, 1.55, 11.9, 5.4, refs, 12.5, TXT, RED, RED, 8, bu='\u25A0', tag=ttl)

check_bounds(prs, 'genu')
prs.save('/tmp/workspace/ortho-decks/Genu_Varum_Valgum_RoyalRed.pptx')
print('\n'.join(WARN) or 'no warnings', len(prs.slides))