"forearm fracture" AND "titanium elastic nail" AND pediatric

TENS titanium elastic nail both bone forearm fracture pediatric functional outcome results

"forearm fracture" AND "elastic nail" AND children

https://www.actaorthopaedica.be/assets/3404/ActaOrthopBelg-8…

TENS both bone forearm fracture pediatric Price criteria Flynn criteria outcomes complications review

https://pmc.ncbi.nlm.nih.gov/articles/PMC8578082

mkdir -p /home/daytona/workspace/tens-synopsis && ls /home/daytona/workspace/ten…

~/tens-synopsis/generate.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "TENS Synopsis - Both Bone Forearm Fractures in Paediatric Age Group";

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// ══════════════════════════════════════════════════════════════════════════════
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    "Peak incidence: 8-14 years of age; Male:Female ratio = 4-7:1.",
    "Mechanism: Fall on an outstretched hand (FOOSH) ~80%; Road traffic accidents ~18-20%.",
    "The forearm functions as a unit — supination/pronation depends on the integrity of both bones and the interosseous membrane.",
    "Malunion or loss of radial bow directly impairs forearm rotation, making anatomical restoration the primary treatment goal.",
    "Unstable, displaced, or irreducible fractures — especially in children >10 years — require surgical fixation to prevent malunion and restore function.",
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — REVIEW OF LITERATURE (1)
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    { auth: "Lascombes et al. (1990)", detail: "J Pediatr Orthop. Introduced elastic stable IM nailing for paediatric forearm fractures — 85 cases. Established foundational three-point fixation principle." },
    { auth: "Luhmann et al. (1998)", detail: "J Pediatr Orthop. Intramedullary fixation of unstable both bone forearm fractures. Demonstrated reliable union and good functional outcomes." },
    { auth: "Flynn & Waters (1996)", detail: "J Pediatr Orthop. Described single bone fixation technique — fixing one bone can restore alignment of both. Comparable outcomes to double nailing." },
    { auth: "Price et al. (1990)", detail: "J Pediatr Orthop. Described malunited forearm fractures in children. Established the Price criteria (ROM + symptoms) for functional outcome assessment." },
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — REVIEW OF LITERATURE (2)
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    { auth: "Kapila et al. (2016) — Prospective, 50 cases", detail: "J Clin Diagn Res. Age 6-14 yrs. Using Price criteria: Excellent 92%, Good 8%, Poor 0%. Superficial pin tract infection in 6%. Concluded TENS is effective with minimal complications." },
    { auth: "Jain et al. (2023) — Retrospective, 65 children", detail: "Acta Orthop Belg. 83.3% received TENS of both bones. Excellent functional results in most. Delayed union 6%, non-union 1.5% (all ulna, all post open reduction). Closed nailing preferred." },
    { auth: "Patel et al. (2014) — Systematic Review", detail: "Injury. No significant difference in functional outcomes between IM nails vs plate fixation. Nailing has lower revision rates and better cosmesis." },
    { auth: "Baldwin et al. (2014) — Meta-analysis", detail: "J Orthop Trauma. Both bone forearm fractures — plates vs nails. Comparable functional outcomes; elastic nailing superior in avoiding growth plate injury and re-operation." },
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — AIMS & OBJECTIVES
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  s.addText("To study the functional outcome in both bone forearm fractures in the paediatric age group (5-15 years) treated with Titanium Elastic Nailing System (TENS) and to evaluate associated complications.", {
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    "To assess radiological outcome — time to union, quality of reduction, and maintenance of radial bow.",
    "To evaluate functional outcome using Price et al. criteria (range of motion of elbow, forearm rotation, and wrist).",
    "To document complications — nail migration, delayed union, non-union, infection, and implant-related issues.",
    "To determine factors influencing outcome — age, fracture level, nail size, open vs closed reduction.",
    "To compare outcomes between single-bone and double-bone TENS fixation.",
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — HYPOTHESIS
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  s.addText("TENS provides excellent functional outcomes (>85% excellent by Price criteria), with a significantly lower rate of malunion and redisplacement compared to conservative management, making it the preferred treatment for unstable paediatric both bone forearm fractures.", {
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — MATERIALS & METHODS
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    ["Follow-up", "Minimum 12 months post-operatively"],
    ["Anaesthesia", "General anaesthesia / regional block"],
    ["Imaging", "Pre-op X-ray (AP & lateral); Intra-op C-arm fluoroscopy; Post-op serial X-rays at 4, 8, 12, 24 weeks"],
    ["Implant", "Titanium elastic nails (1.5 mm, 2 mm, 2.5 mm) — nail diameter = 40% of narrowest canal diameter"],
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — INCLUSION & EXCLUSION CRITERIA
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    "Age <5 years or >15 years",
    "Isolated radius or isolated ulna fractures",
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — OPERATIVE TECHNIQUE
// ══════════════════════════════════════════════════════════════════════════════
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    ["Patient Position", "Supine, arm on radiolucent table, tourniquet applied. C-arm fluoroscopy available throughout."],
    ["Nail Selection", "Nail diameter = 40% of narrowest medullary canal. Typically 2 mm for both radius and ulna (range 1.5-2.5 mm)."],
    ["Radius Entry (Retrograde)", "Stab incision 1-2 cm proximal to distal radial physis at radial styloid. Awl creates entry at 45°. Nail curved to 30-40° arc and inserted retrograde."],
    ["Ulna Entry (Retrograde)", "Stab incision at distal ulna, 1-2 cm proximal to physis. Nail inserted retrograde under fluoroscopy."],
    ["Fracture Reduction", "Closed reduction attempted first. Nail advanced to fracture, fracture reduced, nail crosses fracture and seated in proximal metaphysis."],
    ["Completion", "Nail ends bent 90° and cut 5-10 mm outside cortex. Both bones fixed. Wound closure. Above-elbow slab for 2-3 weeks."],
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — OUTCOME MEASURES
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    const bg = ri % 2 === 0 ? C.white : C.sky;
    s.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 2.65, h: 0.42, fill: { color: pColors[ri] }, line: { color: pColors[ri] } });
    s.addText(res, { x: 0.35, y, w: 2.65, h: 0.42, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
    s.addShape(pres.ShapeType.rect, { x: 3.0, y, w: 4.0, h: 0.42, fill: { color: bg }, line: { color: "CCCCCC", pt: 0.5 } });
    s.addText(rom, { x: 3.0, y, w: 4.0, h: 0.42, fontSize: 10.5, color: C.charcoal, align: "center", valign: "middle", margin: 0 });
    s.addShape(pres.ShapeType.rect, { x: 7.0, y, w: 2.65, h: 0.42, fill: { color: bg }, line: { color: "CCCCCC", pt: 0.5 } });
    s.addText(sym, { x: 7.0, y, w: 2.65, h: 0.42, fontSize: 10.5, color: C.charcoal, align: "center", valign: "middle", margin: 0 });
  });

  // Secondary outcomes
  s.addText("B. RADIOLOGICAL OUTCOME: Time to union (weeks) • Quality of reduction • Maintenance of radial bow • Callus grading (Anthony et al.)", {
    x: 0.35, y: 3.62, w: 9.3, h: 0.42, fontSize: 10.5, color: C.charcoal, fontFace: "Calibri",
    fill: { color: C.white }, line: { color: "DDDDDD" }, margin: 6,
  });
  s.addText("C. COMPLICATION ASSESSMENT: Nail back-out • Infection (superficial / deep) • Delayed union (>16 weeks) • Non-union • Compartment syndrome • Re-fracture", {
    x: 0.35, y: 4.1, w: 9.3, h: 0.42, fontSize: 10.5, color: C.charcoal, fontFace: "Calibri",
    fill: { color: C.white }, line: { color: "DDDDDD" }, margin: 6,
  });
  s.addText("D. IMPLANT REMOVAL: Timing (months post-union) • Ease of removal • Post-removal complications", {
    x: 0.35, y: 4.58, w: 9.3, h: 0.38, fontSize: 10.5, color: C.charcoal, fontFace: "Calibri",
    fill: { color: C.white }, line: { color: "DDDDDD" }, margin: 6,
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — POST-OP PROTOCOL & FOLLOW-UP
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentBg(s);
  addSectionHeader(s, "POST-OPERATIVE PROTOCOL & FOLLOW-UP SCHEDULE");
  addAccentLine(s);

  const timeline = [
    { time: "Day 1-2", detail: "Post-op wound check, neurovascular assessment, above-elbow slab applied." },
    { time: "2-3 Weeks", detail: "Slab removed. Wound inspection. Begin elbow, wrist, and forearm ROM exercises." },
    { time: "4-6 Weeks", detail: "X-ray check (AP & lateral). Assess callus formation. Clinical examination." },
    { time: "8-12 Weeks", detail: "Repeat X-ray. Confirm union (Grade 3 callus — cortical bridging). Full ROM assessment." },
    { time: "4-6 Months\n(Post-union)", detail: "Nail removal under GA/sedation after confirmed radiological union. Protect from contact sports for 4-6 weeks post-removal." },
    { time: "12 Months", detail: "Final functional assessment using Price et al. criteria. Document forearm rotation (supination/pronation), grip strength, and symptoms." },
  ];

  timeline.forEach((item, i) => {
    const y = 1.05 + i * 0.72;
    s.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 1.55, h: 0.62, fill: { color: C.navy }, line: { color: C.navy } });
    s.addText(item.time, { x: 0.35, y, w: 1.55, h: 0.62, fontSize: 10, bold: true, color: C.gold, align: "center", valign: "middle", margin: 2 });
    s.addShape(pres.ShapeType.rect, { x: 1.9, y: y + 0.05, w: 7.7, h: 0.52, fill: { color: C.white }, line: { color: "DDDDDD", pt: 0.5 } });
    s.addText(item.detail, { x: 2.0, y: y + 0.07, w: 7.5, h: 0.46, fontSize: 11, color: C.charcoal, fontFace: "Calibri", valign: "middle", wrap: true });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 — STATISTICAL ANALYSIS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentBg(s);
  addSectionHeader(s, "STATISTICAL ANALYSIS");
  addAccentLine(s);

  const boxes = [
    { title: "Sample Size Calculation", body: "Minimum 30 patients. Based on expected 85% excellent outcomes, 5% margin of error, 95% CI, power = 80%. Formula: n = Z²·p(1-p)/d²." },
    { title: "Descriptive Statistics", body: "Mean, median, standard deviation for continuous variables (age, union time, ROM). Frequency and percentage for categorical variables." },
    { title: "Inferential Statistics", body: "Chi-square test for categorical outcomes. Student's t-test / Mann-Whitney U for continuous variables. Paired t-test for pre/post ROM comparison." },
    { title: "Correlation Analysis", body: "Pearson/Spearman correlation — age vs. outcome; nail size vs. complications; fracture level vs. union time." },
    { title: "Subgroup Analysis", body: "Age (<10 yrs vs. ≥10 yrs). Fracture level (proximal/middle/distal 1/3). Open vs. closed reduction. Single vs. double bone nailing." },
    { title: "Software & Significance", body: "SPSS v26 / MedCalc. p-value <0.05 considered statistically significant. Data presented as tables and graphs." },
  ];

  boxes.forEach((box, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = col === 0 ? 0.35 : 5.25;
    const y = 1.05 + row * 1.4;
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.4, h: 1.3, fill: { color: C.white }, line: { color: "DDDDDD" } });
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.4, h: 0.4, fill: { color: C.teal } });
    s.addText(box.title, { x: x + 0.1, y, w: 4.2, h: 0.4, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
    s.addText(box.body, { x: x + 0.1, y: y + 0.45, w: 4.2, h: 0.8, fontSize: 10, color: C.charcoal, fontFace: "Calibri", wrap: true, valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 — ETHICAL CONSIDERATIONS & BUDGET
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentBg(s);
  addSectionHeader(s, "ETHICAL CONSIDERATIONS & BUDGET");
  addAccentLine(s);

  s.addText("ETHICAL CONSIDERATIONS", { x: 0.35, y: 1.06, w: 9.3, h: 0.38, fontSize: 12.5, bold: true, color: C.navy, fontFace: "Calibri" });
  const ethics = [
    "IEC (Institutional Ethics Committee) approval obtained prior to study commencement.",
    "Written informed consent from parents/legal guardians of all enrolled patients.",
    "Assent obtained from children ≥7 years of age.",
    "All procedures conducted per institutional protocols and Declaration of Helsinki guidelines.",
    "Patient data confidentiality maintained; records anonymised for analysis.",
    "No additional costs imposed on patients; implants provided as per standard care.",
  ];
  s.addText(ethics.map((e, i) => ({ text: e, options: { bullet: true, breakLine: i < ethics.length - 1, fontSize: 11, color: C.charcoal, fontFace: "Calibri", paraSpaceAfter: 3 } })),
    { x: 0.45, y: 1.5, w: 9.1, h: 2.0 });

  s.addShape(pres.ShapeType.rect, { x: 0.35, y: 3.6, w: 9.3, h: 0.04, fill: { color: "DDDDDD" } });
  s.addText("BUDGET (Estimated)", { x: 0.35, y: 3.72, w: 9.3, h: 0.38, fontSize: 12.5, bold: true, color: C.navy, fontFace: "Calibri" });
  s.addText([
    { text: "Implant cost (TENS nails): ", options: { bold: true } },
    { text: "Provided by institution / standard surgical charge     " },
    { text: "Data collection & stationery: ", options: { bold: true } },
    { text: "~₹2,000–5,000     " },
    { text: "Statistical software: ", options: { bold: true } },
    { text: "Institutional license (SPSS)     " },
    { text: "Publication/dissemination: ", options: { bold: true } },
    { text: "~₹5,000–10,000     " },
    { text: "Total self-funded: ", options: { bold: true, color: C.teal } },
    { text: "~₹10,000–15,000", options: { color: C.teal } },
  ], { x: 0.45, y: 4.15, w: 9.1, h: 1.2, fontSize: 11, color: C.charcoal, fontFace: "Calibri", wrap: true });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 — EXPECTED OUTCOMES & SIGNIFICANCE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentBg(s);
  addSectionHeader(s, "EXPECTED OUTCOMES & SIGNIFICANCE");
  addAccentLine(s);

  const exp = [
    { icon: "≥85%", label: "Excellent", sub: "Functional outcome by Price criteria" },
    { icon: "8-11", label: "Weeks", sub: "Average time to radiological union" },
    { icon: "<10%", label: "Major\nComplications", sub: "Delayed union / non-union rate" },
    { icon: "100%", label: "Physis\nSparing", sub: "No growth arrest expected" },
  ];

  exp.forEach((item, i) => {
    const x = 0.35 + i * 2.35;
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.05, w: 2.15, h: 2.3, fill: { color: C.white }, line: { color: "DDDDDD" }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.05, w: 2.15, h: 0.85, fill: { color: C.navy }, line: { color: C.navy }, rectRadius: 0.1 });
    s.addText(item.icon, { x, y: 1.08, w: 2.15, h: 0.78, fontSize: 22, bold: true, color: C.gold, align: "center", valign: "middle", margin: 0 });
    s.addText(item.label, { x, y: 1.97, w: 2.15, h: 0.55, fontSize: 13, bold: true, color: C.teal, align: "center", fontFace: "Calibri", margin: 0 });
    s.addText(item.sub, { x, y: 2.55, w: 2.15, h: 0.72, fontSize: 10, color: C.charcoal, align: "center", fontFace: "Calibri", wrap: true });
  });

  s.addText("SIGNIFICANCE OF THE STUDY", { x: 0.35, y: 3.55, w: 9.3, h: 0.38, fontSize: 12.5, bold: true, color: C.navy, fontFace: "Calibri" });
  const sig = [
    "Provides institutional data on TENS outcomes in a paediatric population — fills gap in Indian literature.",
    "Helps establish evidence-based guidelines for operative vs conservative management thresholds.",
    "Identifies modifiable risk factors (fracture level, nail size, open vs closed reduction) that influence outcome.",
    "Guides surgeons in patient selection, technique optimisation, and counselling of parents regarding prognosis.",
  ];
  s.addText(sig.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < sig.length - 1, fontSize: 11, color: C.charcoal, fontFace: "Calibri", paraSpaceAfter: 4 } })),
    { x: 0.4, y: 3.98, w: 9.2, h: 1.5 });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 16 — REFERENCES
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentBg(s);
  addSectionHeader(s, "REFERENCES");
  addAccentLine(s);

  const refs = [
    "1. Lascombes P, Prevot J, Ligier JN, et al. Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. J Pediatr Orthop. 1990;10:167.",
    "2. Price CT, Scott DS, Kurzner ME, Flynn JC. Malunited forearm fractures in children. J Pediatr Orthop. 1990;10(6):705-12.",
    "3. Flynn JM, Waters PM. Single-bone fixation of both-bone forearm fractures. J Pediatr Orthop. 1996;16(5):655-659.",
    "4. Luhmann SJ, Gordon JE, Schoenecker PL. Intramedullary fixation of unstable both bone forearm fractures in children. J Pediatr Orthop. 1998;18:451.",
    "5. Kapila R, Sharma R, Chugh A, Goyal M. Evaluation of clinical outcomes of paediatric bone forearm fractures using TENS. J Clin Diagn Res. 2016;10:RC12-5.",
    "6. Patel A, Li L, Anand A. Functional outcomes and complications of IM nailing vs plate fixation for both-bone forearm fractures in children. Injury. 2014;45(8):1135-43.",
    "7. Baldwin K, Morrison MJ, Tomlinson LA, et al. Both bone forearm fractures in children — plates or nails? J Orthop Trauma. 2014;28(1):e8-14.",
    "8. Jain S, et al. Outcomes and complications of Titanium elastic nailing for forearm fractures. Acta Orthop Belg. 2023;89:539.",
    "9. Tella AO, Aldhilan MM. Outcome of TEN fixation of pediatric long bone fractures. Orthop Rev. 2024;16.",
    "10. Waters PM, Skaggs DL, Flynn JM. Rockwood and Wilkins Fractures in Children. 9th Ed. Lippincott Williams & Wilkins; 2019.",
    "11. Campbell's Operative Orthopaedics. 15th Ed. 2026. Chapter: Forearm Fractures / Monteggia Fractures.",
  ];

  s.addText(refs.map((r, i) => ({ text: r, options: { breakLine: i < refs.length - 1, fontSize: 9.8, color: C.charcoal, fontFace: "Calibri", paraSpaceAfter: 4 } })),
    { x: 0.35, y: 1.02, w: 9.3, h: 4.42, valign: "top" });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 17 — CLOSING
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navySlide(s);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.12, fill: { color: C.gold } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.505, w: 10, h: 0.12, fill: { color: C.gold } });

  s.addText("THANK YOU", {
    x: 0.5, y: 1.2, w: 9, h: 1.2,
    fontSize: 48, bold: true, color: C.white, fontFace: "Calibri", align: "center", charSpacing: 6,
  });
  s.addShape(pres.ShapeType.rect, { x: 3.5, y: 2.55, w: 3, h: 0.06, fill: { color: C.gold } });
  s.addText("Functional Outcome in Both Bone Forearm Fractures\nin Paediatric Age Group Treated with TENS", {
    x: 0.5, y: 2.75, w: 9, h: 0.85,
    fontSize: 14, color: "AACDE0", fontFace: "Calibri", align: "center", italic: true,
  });
  s.addText("Department of Orthopaedics\n[Institution Name]  |  [University Name]  |  2025-26", {
    x: 0.5, y: 3.75, w: 9, h: 0.75,
    fontSize: 12, color: "AACDE0", fontFace: "Calibri", align: "center",
  });
}

// ─── WRITE FILE ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/tens-synopsis/TENS_Synopsis_BBFF_Paediatric.pptx" })
  .then(() => console.log("DONE"))
  .catch(e => { console.error(e); process.exit(1); });

cd /home/daytona/workspace/tens-synopsis && node generate.js 2>&1

ls -lh /home/daytona/workspace/tens-synopsis/