const pptxgen = require("pptxgenjs");

let pres = new pptxgen();
// Poster layout: wide format (13.3" x 7.5") — ideal for conference posters in landscape
pres.layout = 'LAYOUT_WIDE';
pres.title = 'Neglected Elbow Dislocation - Orthopedic Poster';

let slide = pres.addSlide();

// ─────────────────────────────────────────────
// COLOR PALETTE  (dark navy + teal + white)
// ─────────────────────────────────────────────
const C = {
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  gold:    "E8A020",  // highlight / bullet accent
  white:   "FFFFFF",
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  textDark:"0D2B45",
  textMid: "2D4A62",
  lightBg: "E8F4F6",
};

// ─────────────────────────────────────────────
// BACKGROUND
// ─────────────────────────────────────────────
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  x: 0, y: 0, w: 13.3, h: 7.5,
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  fill: { color: C.gold },
  line: { color: C.gold }
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// ─────────────────────────────────────────────
// HEADER
// ─────────────────────────────────────────────
slide.addText('"What Neglect Froze, Surgery Thawed"', {
  x: 0.3, y: 0.05, w: 12.7, h: 0.5,
  fontSize: 22, bold: true, color: C.gold,
  fontFace: "Calibri", align: "center",
});

slide.addText("Reviving a Neglected Elbow Dislocation — A Case Report with Standard Orthopedic References", {
  x: 0.3, y: 0.55, w: 12.7, h: 0.45,
  fontSize: 13.5, bold: false, color: C.white,
  fontFace: "Calibri", align: "center",
  italic: true
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slide.addText("Reference: Rockwood & Green's Fractures in Adults, 10th Ed. 2025  |  Miller's Review of Orthopaedics, 9th Ed.", {
  x: 0.3, y: 1.0, w: 12.7, h: 0.22,
  fontSize: 8.5, bold: false, color: C.tealLt,
  fontFace: "Calibri", align: "center",
  italic: true
});

// ─────────────────────────────────────────────
// CONTENT AREA BACKGROUND PANELS
// ─────────────────────────────────────────────
// We use a 3-column layout: 0.18 | col1 (3.9") | gap | col2 (4.0") | gap | col3 (4.0") | 0.18
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const colH = 5.85;

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// ─────────────────────────────────────────────
// HELPER: Section Header Bar
// ─────────────────────────────────────────────
function addSectionHeader(slide, x, y, w, label) {
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    fill: { color: C.navyMid },
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    fontFace: "Calibri", align: "left", valign: "middle",
    charSpacing: 1
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}

// ─────────────────────────────────────────────
// HELPER: Body text block
// ─────────────────────────────────────────────
function addBody(slide, x, y, w, h, lines, sz) {
  sz = sz || 8;
  slide.addText(lines, {
    x, y, w, h,
    fontSize: sz, color: C.textDark, fontFace: "Calibri",
    valign: "top", align: "left", wrap: true,
    paraSpaceAfter: 3
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}

// ─────────────────────────────────────────────
// ═══════════  COLUMN 1  ═══════════
// ─────────────────────────────────────────────
const c1x = 0.22, c1w = 3.88;
let c1y = colY + 0.05;

// —— INTRODUCTION ——
addSectionHeader(slide, c1x, c1y, c1w, "INTRODUCTION");
c1y += 0.32;
addBody(slide, c1x + 0.08, c1y, c1w - 0.1, 1.02, [
  { text: "Neglected elbow dislocation", options: { bold: true } },
  { text: " is defined as an unreduced dislocation persisting beyond " },
  { text: "3 weeks", options: { bold: true } },
  { text: ". It is uncommon in developed nations but important in resource-limited settings." },
  { text: "\n\nThe elbow is the ", options: {} },
  { text: "2nd most commonly dislocated joint", options: { bold: true } },
  { text: " in adults (rate: 5.2/100,000 person-years). Posterior dislocation accounts for ~90% of cases, typically following a fall on an outstretched hand." },
  { text: "\n\n", options: {} },
  { text: "Chronic cases develop fibrosis, capsular contracture, heterotopic ossification and altered joint anatomy — making closed reduction impossible.", options: { italic: true, color: C.textMid } }
], 8.0);

c1y += 1.07;

// —— PATHOANATOMY ——
addSectionHeader(slide, c1x, c1y, c1w, "PATHOLOGY & APPLIED ANATOMY");
c1y += 0.32;

// Anatomy sub-box
slide.addShape(pres.ShapeType.rect, {
  x: c1x + 0.05, y: c1y, w: c1w - 0.1, h: 1.05,
  fill: { color: C.lightBg },
  line: { color: C.tealLt, pt: 0.75 }
});
addBody(slide, c1x + 0.12, c1y + 0.04, c1w - 0.22, 0.97, [
  { text: "Medial Collateral Ligament (MCL):\n", options: { bold: true, color: C.navyMid } },
  { text: "  • Anterior band = primary valgus stabilizer (20–120°)\n" },
  { text: "  • Posterior band = secondary stabilizer\n" },
  { text: "Lateral Collateral Ligament (LCL) Complex:\n", options: { bold: true, color: C.navyMid } },
  { text: "  • Lateral ulnar collateral ligament (LUCL) → primary varus/posterolateral rotatory stabilizer\n" },
  { text: "  • Annular ligament → stabilizes proximal radioulnar joint\n" },
  { text: "  • Reconstructed in Tommy John surgery (UCL reconstruction)" },
], 7.5);
c1y += 1.1;

// —— MECHANISM ——
addSectionHeader(slide, c1x, c1y, c1w, "MECHANISM OF INJURY");
c1y += 0.32;
addBody(slide, c1x + 0.08, c1y, c1w - 0.1, 0.82, [
  { text: "O'Driscoll et al. (Rockwood & Green's, p.1648):", options: { bold: true } },
  { text: " Valgus + axial + posterolateral force → sequential disruption LATERAL → MEDIAL:\n" },
  { text: "  1. LCL / lateral capsule disrupted first\n" },
  { text: "  2. Anterior + posterior capsule torn\n" },
  { text: "  3. MCL disrupted last (may be spared in some cases)\n" },
  { text: "Result: ", options: { bold: true } },
  { text: "Posterolateral dislocation of the ulnohumeral joint" }
], 7.8);
c1y += 0.87;

// —— CASE REPORT ——
addSectionHeader(slide, c1x, c1y, c1w, "CASE REPORT");
c1y += 0.32;
addBody(slide, c1x + 0.08, c1y, c1w - 0.1, 1.05, [
  { text: "70-year-old female", options: { bold: true } },
  { text: " presented with left elbow pain and inability to move the limb following a fall ", },
  { text: "3 months prior", options: { bold: true } },
  { text: " at her residence. Initial treatment elsewhere — above-elbow slab immobilization for 6 weeks.\n\n" },
  { text: "Examination: ", options: { bold: true } },
  { text: "Swelling over left elbow • Gross restriction of movements • Only ~20° flexion-extension arc possible • Supination and pronation completely restricted • Altered bony triangle (olecranon, medial/lateral epicondyles) • Olecranon prominently palpable posteriorly • No neurovascular deficit\n\n" },
  { text: "Radiological investigation confirmed neglected posterior elbow dislocation." }
], 7.8);
c1y += 1.1;

// REFERENCE BOX at bottom col1
slide.addShape(pres.ShapeType.rect, {
  x: c1x, y: c1y, w: c1w, h: 0.52,
  fill: { color: C.navyMid },
  line: { color: C.gold, pt: 1 }
});
addBody(slide, c1x + 0.08, c1y + 0.04, c1w - 0.1, 0.44, [
  { text: "REF: ", options: { bold: true, color: C.gold } },
  { text: "Rockwood & Green's Fractures in Adults, 10th Ed. 2025, pp.1648–1656\n", options: { color: C.white } },
  { text: "Miller's Review of Orthopaedics, 9th Ed. — Elbow chapter", options: { color: C.tealLt } }
], 7.5);

// ─────────────────────────────────────────────
// ═══════════  COLUMN 2  ═══════════
// ─────────────────────────────────────────────
const c2x = 4.38, c2w = 4.18;
let c2y = colY + 0.05;

// —— PRE-OPERATIVE ——
addSectionHeader(slide, c2x, c2y, c2w, "PREOPERATIVE PLANNING");
c2y += 0.32;
addBody(slide, c2x + 0.08, c2y, c2w - 0.1, 0.73, [
  { text: "Per Rockwood & Green's ORIF checklist (p.1652):\n", options: { bold: true } },
  { text: "  • Supine positioning with arm table\n" },
  { text: "  • Fluoroscopy available\n" },
  { text: "  • Neurovascular assessment (ulnar nerve most at risk)\n" },
  { text: "  • Assess for HO, soft-tissue contracture, and joint congruity\n" },
  { text: "  • Plan for collateral ligament repair/reconstruction" }
], 7.8);
c2y += 0.78;

// —— TREATMENT ——
addSectionHeader(slide, c2x, c2y, c2w, "SURGICAL TREATMENT");
c2y += 0.32;

// Treatment approach box
slide.addShape(pres.ShapeType.rect, {
  x: c2x + 0.05, y: c2y, w: c2w - 0.1, h: 1.55,
  fill: { color: C.lightBg },
  line: { color: C.tealLt, pt: 0.75 }
});
addBody(slide, c2x + 0.12, c2y + 0.04, c2w - 0.22, 1.47, [
  { text: "Posterior approach", options: { bold: true, color: C.navyMid } },
  { text: " to the elbow (preserving the triceps mechanism per Anderson et al.)\n\n" },
  { text: "  ✦ Careful dissection & soft-tissue release\n" },
  { text: "  ✦ Mobilization of the ulnar nerve (most commonly injured nerve post-dislocation)\n" },
  { text: "  ✦ Removal of scar tissue and heterotopic ossification\n" },
  { text: "  ✦ Open reduction of elbow joint\n" },
  { text: "  ✦ Confirmed reduction under C-arm fluoroscopy\n" },
  { text: "  ✦ K-wire fixation for stability\n" },
  { text: "  ✦ ", options: {} },
  { text: "Bell-Tawse annular ligament reconstruction", options: { bold: true, color: C.navyMid } },
  { text: " (LCL complex restoration)\n" },
  { text: "  ✦ ", options: {} },
  { text: "Tommy John UCL (medial collateral ligament) repair", options: { bold: true, color: C.navyMid } },
  { text: " — ulnar nerve protected\n" },
  { text: "  ✦ Medial & lateral soft-tissue sleeves repaired with transosseous sutures\n" },
  { text: "  ✦ Early physiotherapy commenced with sling limiting extension" }
], 7.8);
c2y += 1.6;

// —— RATIONALE BOX ——
addSectionHeader(slide, c2x, c2y, c2w, "SURGICAL RATIONALE (ROCKWOOD & GREEN'S)");
c2y += 0.32;
addBody(slide, c2x + 0.08, c2y, c2w - 0.1, 0.95, [
  { text: "\"Chronic dislocations are more commonly seen in the developing world... surgeons recommend a ", options: { color: C.textDark } },
  { text: "posterior approach preserving the triceps", options: { bold: true, color: C.navyMid } },
  { text: " — both to improve motion and to provide stability postoperatively.\"\n\n" },
  { text: "Anderson et al. series (32 patients, Ethiopia): ", options: { bold: true } },
  { text: "97% achieved good-to-excellent functional outcome using combined medial + lateral approach without violating the extensor mechanism. Early motion commenced with sling.", options: { italic: true } }
], 7.8);
c2y += 1.0;

// —— COMPLICATIONS ——
addSectionHeader(slide, c2x, c2y, c2w, "EXPECTED COMPLICATIONS");
c2y += 0.32;
addBody(slide, c2x + 0.08, c2y, c2w - 0.1, 0.65, [
  { text: "  • Residual stiffness (<10% report instability — Rockwood & Green's)\n" },
  { text: "  • Ulnar nerve injury (most common nerve complication)\n" },
  { text: "  • Median nerve entrapment in joint post-reduction (rare)\n" },
  { text: "  • Heterotopic ossification and recurrent instability\n" },
  { text: "  • Brachial artery injury (rare in chronic cases)" }
], 7.8);
c2y += 0.7;

// —— DISCUSSION ——
addSectionHeader(slide, c2x, c2y, c2w, "DISCUSSION");
c2y += 0.32;
addBody(slide, c2x + 0.08, c2y, c2w - 0.1, 0.88, [
  { text: "Neglected elbow dislocations are challenging due to fibrosis, capsular contracture, stiffness, and altered joint anatomy following prolonged dislocation. Closed reduction is rarely possible after 3 weeks.\n\n" },
  { text: "In our patient, open reduction with Bell-Tawse annular ligament reconstruction and Tommy John UCL repair restored joint stability and functional range of motion. Early physiotherapy improved postoperative recovery and daily function." }
], 7.8);
c2y += 0.93;

// REFERENCE bottom col2
slide.addShape(pres.ShapeType.rect, {
  x: c2x, y: c2y, w: c2w, h: 0.52,
  fill: { color: C.navyMid },
  line: { color: C.gold, pt: 1 }
});
addBody(slide, c2x + 0.08, c2y + 0.04, c2w - 0.1, 0.44, [
  { text: "REF: ", options: { bold: true, color: C.gold } },
  { text: "Rockwood & Green's, 10th Ed. 2025 — Chapter 40: Simple Elbow Dislocation\n", options: { color: C.white } },
  { text: "Anderson et al. — Operative management of missed dislocations (Ethiopia)", options: { color: C.tealLt, italic: true } }
], 7.5);

// ─────────────────────────────────────────────
// ═══════════  COLUMN 3  ═══════════
// ─────────────────────────────────────────────
const c3x = 8.84, c3w = 4.24;
let c3y = colY + 0.05;

// —— CLASSIFICATION ——
addSectionHeader(slide, c3x, c3y, c3w, "CLASSIFICATION OF ELBOW DISLOCATIONS");
c3y += 0.32;

// Classification table-style boxes
const classItems = [
  { label: "Posterior (most common ~80%)", desc: "Posterolateral > posteromedial" },
  { label: "Anterior", desc: "Rare; often associated with olecranon fracture" },
  { label: "Medial / Lateral", desc: "Uncommon; divergent is rare" },
  { label: "Simple", desc: "No fracture (our case)" },
  { label: "Complex", desc: "Associated radial head / coronoid fracture (Terrible Triad)" },
];
classItems.forEach((item, i) => {
  const bx = c3x + 0.05, by = c3y + i * 0.36;
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    x: bx, y: by, w: c3w - 0.1, h: 0.32,
    fill: { color: i % 2 === 0 ? C.lightBg : C.offWhite },
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    x: bx, y: by, w: 0.05, h: 0.32,
    fill: { color: C.teal },
    line: { color: C.teal }
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  slide.addText([
    { text: item.label + " — ", options: { bold: true, color: C.navyMid } },
    { text: item.desc, options: { color: C.textDark } }
  ], { x: bx + 0.1, y: by, w: c3w - 0.22, h: 0.32, fontSize: 7.5, valign: "middle", fontFace: "Calibri" });
});
c3y += classItems.length * 0.36 + 0.06;

// —— ASSESSMENT ——
addSectionHeader(slide, c3x, c3y, c3w, "CLINICAL ASSESSMENT");
c3y += 0.32;
addBody(slide, c3x + 0.08, c3y, c3w - 0.1, 0.88, [
  { text: "Signs & Symptoms:\n", options: { bold: true } },
  { text: "  • Obvious deformity (swelling, ecchymosis, restricted ROM)\n" },
  { text: "  • Altered bony triangle (3 bony prominences)\n" },
  { text: "  • Olecranon palpable posteriorly\n" },
  { text: "  • Ulnar nerve — must assess (most commonly injured)\n" },
  { text: "\nImaging: ", options: { bold: true } },
  { text: "AP + lateral elbow X-rays confirm posterolateral dislocation. Assess for associated fractures (terrible triad). MRI for ligament evaluation if needed." }
], 7.8);
c3y += 0.93;

// —— OUTCOME ——
addSectionHeader(slide, c3x, c3y, c3w, "OUTCOMES — 4 MONTHS POSTOPERATIVE");
c3y += 0.32;

// Outcome highlight boxes
const outcomes = [
  { icon: "✓", text: "Significant improvement in range of motion" },
  { icon: "✓", text: "Full supination and pronation restored" },
  { icon: "✓", text: "Joint stability achieved bilaterally" },
  { icon: "✓", text: "No neurovascular deficit at follow-up" },
  { icon: "✓", text: "Functional daily activities resumed" },
];
outcomes.forEach((o, i) => {
  const bx = c3x + 0.05, by = c3y + i * 0.31;
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    x: bx, y: by, w: c3w - 0.1, h: 0.27,
    fill: { color: i % 2 === 0 ? C.lightBg : C.offWhite },
    line: { color: C.teal, pt: 0.5 }
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  slide.addText([
    { text: o.icon + "  ", options: { bold: true, color: C.teal } },
    { text: o.text, options: { color: C.textDark } }
  ], { x: bx + 0.08, y: by, w: c3w - 0.2, h: 0.27, fontSize: 8, valign: "middle", fontFace: "Calibri" });
});
c3y += outcomes.length * 0.31 + 0.08;

// —— CONCLUSION ——
addSectionHeader(slide, c3x, c3y, c3w, "CONCLUSION");
c3y += 0.32;

slide.addShape(pres.ShapeType.rect, {
  x: c3x + 0.05, y: c3y, w: c3w - 0.1, h: 0.72,
  fill: { color: "1A3F5C" },
  line: { color: C.gold, pt: 1.5 }
});
addBody(slide, c3x + 0.12, c3y + 0.06, c3w - 0.24, 0.62, [
  { text: "Chronic neglected elbow dislocations are NOT \"surgical lost causes\".\n\n", options: { bold: true, color: C.gold } },
  { text: "Early awareness, timely referral, and tailored reconstruction can restore function at any age — even in a 70-year-old after 3 months of neglect.", options: { color: C.white } }
], 8.2);
c3y += 0.78;

// —— REFERENCES ——
addSectionHeader(slide, c3x, c3y, c3w, "REFERENCES");
c3y += 0.32;
addBody(slide, c3x + 0.08, c3y, c3w - 0.1, 1.0, [
  { text: "1. ", options: { bold: true, color: C.navyMid } },
  { text: "Rockwood & Green's Fractures in Adults, 10th Ed. 2025 — Chapter 40: Simple Elbow Dislocation, pp. 1648–1660\n\n" },
  { text: "2. ", options: { bold: true, color: C.navyMid } },
  { text: "Miller's Review of Orthopaedics, 9th Ed. — Elbow Injuries; UCL/Tommy John reconstruction; Annular ligament anatomy\n\n" },
  { text: "3. ", options: { bold: true, color: C.navyMid } },
  { text: "Freeman III BL. Old unreduced dislocations. In: Crenshaw AH, ed. Campbell's Operative Orthopaedics, 9th ed. St. Louis: Mosby; 1998. p.2673–4\n\n" },
  { text: "4. ", options: { bold: true, color: C.navyMid } },
  { text: "Elzohairy MM. Neglected posterior dislocation of the elbow. Injury. 2009;40:197–200\n\n" },
  { text: "5. ", options: { bold: true, color: C.navyMid } },
  { text: "Anderson et al. Operative management of 32 missed elbow dislocations. Reported 97% good-to-excellent outcomes." }
], 7.5);

// ─────────────────────────────────────────────
// FOOTER
// ─────────────────────────────────────────────
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  x: 0, y: 7.3, w: 13.3, h: 0.2,
  fill: { color: C.teal },
  line: { color: C.teal }
});
slide.addText("Orthopedic Surgery Department  |  Standard references: Rockwood & Green's Fractures in Adults 10th Ed. 2025  +  Miller's Review of Orthopaedics 9th Ed.  |  Case Report 2025", {
  x: 0, y: 7.3, w: 13.3, h: 0.2,
  fontSize: 6.5, color: C.white, fontFace: "Calibri", align: "center", valign: "middle"
});

// ─────────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/elbow-poster/Neglected_Elbow_Dislocation_Poster.pptx" })
  .then(() => console.log("✅ Poster created successfully"))
  .catch(e => console.error("❌ Error:", e));