History Taking and Examination Proforma: Malunion of the Humerus

from docx import Document
from docx.shared import Pt, Inches, RGBColor, Cm
from docx.enum.text import WD_ALIGN_PARAGRAPH
from docx.enum.table import WD_TABLE_ALIGNMENT, WD_ALIGN_VERTICAL
from docx.oxml.ns import qn
from docx.oxml import OxmlElement
import copy

doc = Document()

# ── Page margins (A4, 1.5 cm all round for print) ──────────────────────────
section = doc.sections[0]
section.page_height = Cm(29.7)
section.page_width  = Cm(21.0)
section.left_margin   = Cm(1.6)
section.right_margin  = Cm(1.6)
section.top_margin    = Cm(1.5)
section.bottom_margin = Cm(1.5)

# ── Default font ────────────────────────────────────────────────────────────
style = doc.styles["Normal"]
style.font.name = "Arial"
style.font.size = Pt(9)

# ── Helper: set table cell shading ─────────────────────────────────────────
def shade_cell(cell, hex_color):
    tc = cell._tc
    tcPr = tc.get_or_add_tcPr()
    shd = OxmlElement("w:shd")
    shd.set(qn("w:val"), "clear")
    shd.set(qn("w:color"), "auto")
    shd.set(qn("w:fill"), hex_color)
    tcPr.append(shd)

def set_cell_border(cell, **kwargs):
    """Set cell borders. kwargs: top, bottom, left, right each a dict with
    keys: sz (border size in 1/8pt), val, color."""
    tc = cell._tc
    tcPr = tc.get_or_add_tcPr()
    tcBorders = OxmlElement("w:tcBorders")
    for edge in ("top", "left", "bottom", "right", "insideH", "insideV"):
        border_data = kwargs.get(edge)
        if border_data is not None:
            tag = OxmlElement(f"w:{{edge}}".replace("{edge}", edge))
            tag.set(qn("w:val"), border_data.get("val", "single"))
            tag.set(qn("w:sz"), str(border_data.get("sz", 4)))
            tag.set(qn("w:space"), "0")
            tag.set(qn("w:color"), border_data.get("color", "000000"))
            tcBorders.append(tag)
    tcPr.append(tcBorders)

def heading_para(doc, text, level=1, color="1F3864"):
    p = doc.add_paragraph()
    p.style = f"Heading {level}"
    run = p.add_run(text)
    run.font.color.rgb = RGBColor.from_string(color)
    run.font.name = "Arial"
    run.font.size = Pt(11 if level == 1 else 9.5)
    run.font.bold = True
    return p

def section_bar(doc, text):
    """Dark blue full-width bar heading."""
    tbl = doc.add_table(rows=1, cols=1)
    tbl.style = "Table Grid"
    tbl.autofit = False
    tbl.columns[0].width = Inches(7.3)
    cell = tbl.rows[0].cells[0]
    shade_cell(cell, "1F3864")
    p = cell.paragraphs[0]
    p.alignment = WD_ALIGN_PARAGRAPH.LEFT
    run = p.add_run(f"  {text}")
    run.font.name = "Arial"
    run.font.size = Pt(9.5)
    run.font.bold = True
    run.font.color.rgb = RGBColor(0xFF, 0xFF, 0xFF)
    p.paragraph_format.space_before = Pt(2)
    p.paragraph_format.space_after  = Pt(2)
    doc.add_paragraph()  # small spacer

def sub_bar(doc, text):
    """Light blue sub-section bar."""
    tbl = doc.add_table(rows=1, cols=1)
    tbl.style = "Table Grid"
    tbl.autofit = False
    tbl.columns[0].width = Inches(7.3)
    cell = tbl.rows[0].cells[0]
    shade_cell(cell, "BDD7EE")
    p = cell.paragraphs[0]
    run = p.add_run(f"  {text}")
    run.font.name = "Arial"
    run.font.size = Pt(9)
    run.font.bold = True
    run.font.color.rgb = RGBColor(0x1F, 0x38, 0x64)
    p.paragraph_format.space_before = Pt(1)
    p.paragraph_format.space_after  = Pt(1)
    doc.add_paragraph()

def small(text, bold=False):
    return ("**" if bold else "") + text

def add_field_row(table, label, width_label=2.5, width_field=4.8):
    row = table.add_row()
    c0, c1 = row.cells[0], row.cells[1]
    c0.width = Inches(width_label)
    c1.width = Inches(width_field)
    shade_cell(c0, "EBF3FB")
    p0 = c0.paragraphs[0]
    r = p0.add_run(label)
    r.font.name = "Arial"; r.font.size = Pt(8.5); r.font.bold = True
    # leave c1 blank for handwriting
    p1 = c1.paragraphs[0]
    p1.add_run("")
    return row

def make_two_col_table(doc, rows_data, col1_w=3.5, col2_w=3.8):
    """rows_data: list of (label, field_placeholder)"""
    tbl = doc.add_table(rows=0, cols=2)
    tbl.style = "Table Grid"
    tbl.autofit = False
    for label, placeholder in rows_data:
        row = tbl.add_row()
        c0, c1 = row.cells[0], row.cells[1]
        c0.width = Inches(col1_w)
        c1.width = Inches(col2_w)
        shade_cell(c0, "EBF3FB")
        p0 = c0.paragraphs[0]
        r = p0.add_run(label)
        r.font.name = "Arial"; r.font.size = Pt(8.5); r.font.bold = True
        p1 = c1.paragraphs[0]
        rr = p1.add_run(placeholder)
        rr.font.name = "Arial"; rr.font.size = Pt(8); rr.font.color.rgb = RGBColor(0x99,0x99,0x99)
    return tbl

def make_check_table(doc, items, cols=3):
    """Checkbox table with items laid out in cols columns."""
    n_rows = -(-len(items) // cols)  # ceiling division
    tbl = doc.add_table(rows=n_rows, cols=cols)
    tbl.style = "Table Grid"
    tbl.autofit = False
    col_w = Inches(7.3 / cols)
    idx = 0
    for r in range(n_rows):
        for c in range(cols):
            cell = tbl.rows[r].cells[c]
            cell.width = col_w
            if idx < len(items):
                p = cell.paragraphs[0]
                run = p.add_run(f"☐  {items[idx]}")
                run.font.name = "Arial"; run.font.size = Pt(8.5)
                idx += 1
    return tbl

def make_rom_table(doc):
    headers = ["Movement", "Normal", "Affected", "Contralateral", "Notes"]
    widths  = [2.0, 0.9, 1.0, 1.2, 2.2]
    rows = [
        ("SHOULDER", "", "", "", ""),
        ("Forward Flexion", "0-180°", "", "", ""),
        ("Extension", "0-60°", "", "", ""),
        ("Abduction", "0-180°", "", "", ""),
        ("Adduction", "0-45°", "", "", ""),
        ("External Rotation (arm at side)", "0-60°", "", "", ""),
        ("Internal Rotation (hand behind back - level reached)", "T7", "", "", ""),
        ("ELBOW", "", "", "", ""),
        ("Flexion", "0-145°", "", "", ""),
        ("Extension", "0°", "", "", ""),
        ("Supination", "0-90°", "", "", ""),
        ("Pronation", "0-90°", "", "", ""),
        ("WRIST / HAND", "", "", "", ""),
        ("Grip Strength (dynamometer / comparison)", "Equal", "", "", ""),
    ]
    tbl = doc.add_table(rows=1, cols=5)
    tbl.style = "Table Grid"
    tbl.autofit = False
    hdr = tbl.rows[0]
    for i, (h, w) in enumerate(zip(headers, widths)):
        cell = hdr.cells[i]
        cell.width = Inches(w)
        shade_cell(cell, "1F3864")
        p = cell.paragraphs[0]
        r = p.add_run(h)
        r.font.name = "Arial"; r.font.size = Pt(8.5); r.font.bold = True
        r.font.color.rgb = RGBColor(0xFF, 0xFF, 0xFF)
        p.alignment = WD_ALIGN_PARAGRAPH.CENTER
    for row_data in rows:
        row = tbl.add_row()
        is_header = row_data[1] == "" and row_data[0] in ("SHOULDER", "ELBOW", "WRIST / HAND")
        for i, (val, w) in enumerate(zip(row_data, widths)):
            cell = row.cells[i]
            cell.width = Inches(w)
            if is_header:
                shade_cell(cell, "BDD7EE")
            p = cell.paragraphs[0]
            r = p.add_run(val)
            r.font.name = "Arial"
            r.font.size = Pt(8.5)
            if is_header:
                r.font.bold = True; r.font.color.rgb = RGBColor(0x1F, 0x38, 0x64)
    return tbl

def make_nerve_table(doc):
    headers = ["Nerve", "Motor Test", "Power (/5)", "Sensory Area", "Intact / Impaired"]
    widths  = [1.5, 2.0, 0.8, 2.0, 1.0]
    data = [
        ("Axillary (C5/6)", "Deltoid abduction vs resistance", "", "Regimental badge area (lat. upper arm)", ""),
        ("Radial (C6-8)", "Wrist extension, finger/thumb extension", "", "Dorsum hand, 1st dorsal web space", ""),
        ("Musculocutaneous (C5/6)", "Elbow flexion in supination (biceps)", "", "Lateral forearm", ""),
        ("Median (C6-T1)", "Wrist flexion, FPL, thenar pinch", "", "Radial 3.5 digits, palm", ""),
        ("Ulnar (C8/T1)", "Finger abduction/adduction, Froment's sign", "", "Medial 1.5 digits, hypothenar", ""),
    ]
    tbl = doc.add_table(rows=1, cols=5)
    tbl.style = "Table Grid"
    tbl.autofit = False
    hdr = tbl.rows[0]
    for i, (h, w) in enumerate(zip(headers, widths)):
        cell = hdr.cells[i]
        cell.width = Inches(w)
        shade_cell(cell, "1F3864")
        p = cell.paragraphs[0]
        r = p.add_run(h)
        r.font.name = "Arial"; r.font.size = Pt(8.5); r.font.bold = True
        r.font.color.rgb = RGBColor(0xFF, 0xFF, 0xFF)
    for row_data in data:
        row = tbl.add_row()
        for i, (val, w) in enumerate(zip(row_data, widths)):
            cell = row.cells[i]
            cell.width = Inches(w)
            if i == 0: shade_cell(cell, "EBF3FB")
            p = cell.paragraphs[0]
            r = p.add_run(val)
            r.font.name = "Arial"; r.font.size = Pt(8.5)
            if i == 0: r.font.bold = True
    return tbl

def make_special_tests_table(doc):
    tests = [
        ("Neer's impingement", "Positive / Negative"),
        ("Hawkins-Kennedy", "Positive / Negative"),
        ("Empty Can (supraspinatus)", "Positive / Negative"),
        ("Drop Arm Test", "Positive / Negative"),
        ("Lift-Off (subscapularis)", "Positive / Negative"),
        ("External Rotation Lag Sign", "Positive / Negative"),
        ("Speed's Test (biceps)", "Positive / Negative"),
        ("Yergason's Test", "Positive / Negative"),
        ("Cross-Arm Adduction (AC joint)", "Positive / Negative"),
        ("Load-and-Shift (instability)", "Grade 0 / 1 / 2 / 3"),
        ("Sulcus Sign (inferior instability)", "Grade 0 / 1+ / 2+ / 3+"),
        ("Anterior Apprehension", "Positive / Negative"),
        ("Posterior Jerk Test", "Positive / Negative"),
        ("Subacromial Injection Response", "Good / Partial / None"),
    ]
    tbl = doc.add_table(rows=1, cols=4)
    tbl.style = "Table Grid"
    tbl.autofit = False
    widths = [1.9, 1.75, 1.9, 1.75]
    for i, (h, w) in enumerate(zip(["Test", "Result", "Test", "Result"], widths)):
        cell = tbl.rows[0].cells[i]
        cell.width = Inches(w)
        shade_cell(cell, "1F3864")
        p = cell.paragraphs[0]
        r = p.add_run(h)
        r.font.name = "Arial"; r.font.size = Pt(8.5); r.font.bold = True
        r.font.color.rgb = RGBColor(0xFF, 0xFF, 0xFF)
    # fill rows in pairs
    for i in range(0, len(tests), 2):
        row = tbl.add_row()
        t1, v1 = tests[i]
        t2, v2 = tests[i+1] if i+1 < len(tests) else ("", "")
        for ci, (text, w, bg) in enumerate(zip(
            [t1, v1, t2, v2],
            widths,
            ["EBF3FB", "FFFFFF", "EBF3FB", "FFFFFF"]
        )):
            cell = row.cells[ci]
            cell.width = Inches(w)
            shade_cell(cell, bg)
            p = cell.paragraphs[0]
            r = p.add_run(text)
            r.font.name = "Arial"; r.font.size = Pt(8.5)
            if ci in (0, 2): r.font.bold = True
    return tbl

def spacer(doc, pts=4):
    p = doc.add_paragraph()
    p.paragraph_format.space_before = Pt(0)
    p.paragraph_format.space_after  = Pt(pts)
    return p

# ============================================================
# TITLE HEADER
# ============================================================
tbl_hdr = doc.add_table(rows=1, cols=1)
tbl_hdr.style = "Table Grid"
tbl_hdr.autofit = False
tbl_hdr.columns[0].width = Inches(7.3)
c = tbl_hdr.rows[0].cells[0]
shade_cell(c, "1F3864")
p = c.paragraphs[0]
p.alignment = WD_ALIGN_PARAGRAPH.CENTER
r = p.add_run("ORTHOPAEDIC CLINIC  —  MALUNION OF THE HUMERUS")
r.font.name = "Arial"; r.font.size = Pt(13); r.font.bold = True
r.font.color.rgb = RGBColor(0xFF, 0xFF, 0xFF)
p.paragraph_format.space_before = Pt(4)
p.paragraph_format.space_after  = Pt(4)
spacer(doc, 4)

# ============================================================
# PART 1 — PATIENT DEMOGRAPHICS
# ============================================================
section_bar(doc, "PART 1 — PATIENT DETAILS")
tbl1 = doc.add_table(rows=0, cols=4)
tbl1.style = "Table Grid"
tbl1.autofit = False
widths4 = [1.5, 2.2, 1.5, 2.1]

def add_4col_row(tbl, labels, widths):
    row = tbl.add_row()
    for i, (lbl, w) in enumerate(zip(labels, widths)):
        cell = row.cells[i]
        cell.width = Inches(w)
        if i % 2 == 0:
            shade_cell(cell, "EBF3FB")
        p = cell.paragraphs[0]
        r = p.add_run(lbl)
        r.font.name = "Arial"; r.font.size = Pt(8.5)
        if i % 2 == 0: r.font.bold = True

add_4col_row(tbl1, ["Patient Name:", "", "Date:", ""], widths4)
add_4col_row(tbl1, ["Age:", "", "Sex:  M / F", ""], widths4)
add_4col_row(tbl1, ["Occupation:", "", "Dominant Hand:  R / L", ""], widths4)
add_4col_row(tbl1, ["Referral Source:", "", "Clinician:", ""], widths4)
add_4col_row(tbl1, ["Hospital No:", "", "Clinic:", ""], widths4)
spacer(doc, 4)

# ============================================================
# PART 2 — HISTORY
# ============================================================
section_bar(doc, "PART 2 — HISTORY")

sub_bar(doc, "2A. Chief Complaints  (tick all that apply)")
items_cc = ["Pain", "Deformity / cosmesis", "Weakness", "Stiffness / restricted ROM",
            "Numbness / tingling", "Inability to perform ADLs", "Night pain", "Other: ________"]
make_check_table(doc, items_cc, cols=4)
spacer(doc, 4)

sub_bar(doc, "2B. Original Injury")
make_two_col_table(doc, [
    ("Date of original injury:", ""),
    ("Mechanism:", "Fall on outstretched hand / direct blow / RTA / pathological / other"),
    ("Energy level:", "Low velocity / High velocity"),
    ("Fracture type:", "Proximal humerus / Shaft / Distal humerus / Supracondylar"),
    ("Open or closed:", "Open / Closed"),
    ("Level of malunion:", "Head-shaft / Tuberosity / Diaphyseal / Distal"),
], col1_w=2.4, col2_w=4.9)
spacer(doc, 4)

sub_bar(doc, "2C. Previous Treatment")
make_two_col_table(doc, [
    ("Treatment given:", "Non-operative: Sling / Cast / Brace    Operative: ORIF / IMN / Arthroplasty"),
    ("Implant used (if operative):", ""),
    ("Duration of immobilisation:", ""),
    ("Date fracture declared united:", ""),
    ("Previous nerve palsy at time of injury:", "Yes / No — nerve: ________________"),
    ("Previous vascular injury:", "Yes / No"),
    ("Infection / wound complications:", "Yes / No — details: _______________"),
], col1_w=2.8, col2_w=4.5)
spacer(doc, 4)

sub_bar(doc, "2D. Current Symptoms")
make_two_col_table(doc, [
    ("Pain — Site:", "Anterior deltoid / Lateral arm / Elbow / Forearm / Other: _______"),
    ("Pain — Character:", "Aching / Sharp / Burning / Throbbing"),
    ("Pain — Aggravated by:", "Overhead activity / Abduction / Forward flexion / Internal rotation / Lifting"),
    ("Pain — Relieved by:", "Rest / Analgesia / Sling / Other: _______"),
    ("Pain — Night pain:", "Yes / No"),
    ("VAS / NRS score (0-10):", "  /10"),
    ("Stiffness — direction:", "Flexion / Abduction / ER / IR"),
    ("Weakness — movement:", "Abduction / ER / IR / Elbow flexion / Extension"),
    ("Paraesthesia / numbness:", "Distribution: ______________________ Constant / Intermittent"),
    ("Duration of symptoms:", ""),
    ("Progression:", "Getting worse / Static / Improving"),
], col1_w=2.8, col2_w=4.5)
spacer(doc, 4)

sub_bar(doc, "2E. Functional Assessment")
make_two_col_table(doc, [
    ("Can dress independently:", "Yes / No / With difficulty"),
    ("Can comb hair / reach shelf:", "Yes / No / With difficulty"),
    ("Can carry shopping / lift:", "Yes / No / With difficulty"),
    ("Occupational impact:", "None / Restricted duties / Unable to work"),
    ("Sport / recreational impact:", "None / Reduced / Unable to participate"),
    ("DASH Score:", "  /100    (complete separately)"),
    ("Constant-Murley Score:", "  /100    (complete separately)"),
    ("Oxford Shoulder Score:", "  /48     (complete separately)"),
], col1_w=2.8, col2_w=4.5)
spacer(doc, 4)

sub_bar(doc, "2F. Past Medical History")
make_two_col_table(doc, [
    ("Previous fractures same limb:", "Yes / No — details: _______________"),
    ("Previous shoulder / elbow surgery:", "Yes / No — details: _______________"),
    ("Osteoporosis / metabolic bone disease:", "Yes / No"),
    ("Diabetes mellitus:", "Yes / No — HbA1c: _______"),
    ("Rheumatoid arthritis / inflammatory:", "Yes / No"),
    ("Malignancy:", "Yes / No — type: _______________"),
    ("Peripheral neuropathy:", "Yes / No"),
    ("Other relevant conditions:", ""),
], col1_w=2.8, col2_w=4.5)
spacer(doc, 4)

sub_bar(doc, "2G. Drug, Social & Family History")
make_two_col_table(doc, [
    ("Current analgesics:", ""),
    ("Steroids / bisphosphonates / DMARDs:", "Yes / No — details: _______________"),
    ("Anticoagulants:", "Yes / No — agent: _______________"),
    ("Smoking:", "Non-smoker / Ex-smoker / Current: ___  pack-years"),
    ("Alcohol:", "Units/week: _______"),
    ("Living situation:", "Independent / Family support / Carer"),
    ("Family history (metabolic bone disease):", "Yes / No — details: _______________"),
], col1_w=2.8, col2_w=4.5)
spacer(doc, 6)

# ============================================================
# PART 3 — EXAMINATION
# ============================================================
section_bar(doc, "PART 3 — CLINICAL EXAMINATION")

sub_bar(doc, "3A. General Inspection")
make_two_col_table(doc, [
    ("General build / nutritional status:", ""),
    ("Cervical spine deformity:", "None / Restricted — exclude referred pain"),
    ("Compensatory posture:", "None / Protracted shoulder / Head tilt / Other"),
], col1_w=2.8, col2_w=4.5)
spacer(doc, 4)

sub_bar(doc, "3B. LOOK (Inspection — both arms exposed)")
make_two_col_table(doc, [
    ("Shoulder asymmetry:", "None / Lowered / Protracted / Elevated (affected side)"),
    ("Deltoid bulk:", "Normal / Wasted (axillary nerve / disuse)"),
    ("Supraspinatus / infraspinatus fossa:", "Normal / Wasted (suprascapular nerve / cuff)"),
    ("Visible deformity:", "None / Varus / Valgus / Anterior bow / Rotational / Cubitus varus"),
    ("Scars / sinuses:", "None / Anterior / Lateral / Posterior / Sinus present"),
    ("Swelling / callus:", "None / Localised — site: _______________"),
    ("Scapular winging:", "None / Present (long thoracic nerve)"),
    ("Skin changes:", "Normal / Erythema / Skin tenting / Trophic changes"),
    ("Greater tuberosity prominence:", "Not visible / Visible"),
    ("Carrying angle (elbow):", "Normal / Cubitus varus / Cubitus valgus  — degrees: ______"),
], col1_w=2.8, col2_w=4.5)
spacer(doc, 4)

sub_bar(doc, "3C. FEEL (Palpation)")
make_two_col_table(doc, [
    ("Sternoclavicular joint:", "Non-tender / Tender"),
    ("Clavicle:", "Intact / Tender / Step deformity"),
    ("Acromioclavicular joint:", "Non-tender / Tender / Step"),
    ("Acromion process:", "Non-tender / Tender"),
    ("Coracoid process:", "Non-tender / Tender"),
    ("Greater tuberosity:", "Normal position / Superior migration / Post-medial"),
    ("Bicipital groove / biceps tendon:", "Non-tender / Tender"),
    ("Glenohumeral joint line:", "Anterior: ______  Posterior: ______"),
    ("Humeral shaft palpation:", "No tenderness / Tender at: ______  Step / Callus / Angulation"),
    ("Lateral epicondyle:", "Non-tender / Tender"),
    ("Medial epicondyle:", "Non-tender / Tender / Tinel's sign present"),
    ("Limb length — acromion to lat. epicondyle:", "Affected: _____ cm   Contralateral: _____ cm"),
    ("Mid-arm girth (deltoid level):", "Affected: _____ cm   Contralateral: _____ cm"),
    ("Local temperature:", "Normal / Warm (infection?) / Cold (vascular?)"),
], col1_w=2.8, col2_w=4.5)
spacer(doc, 4)

sub_bar(doc, "3D. MOVE — Range of Motion (degrees, active / passive)")
make_rom_table(doc)
spacer(doc, 4)

sub_bar(doc, "3E. Special Tests (Shoulder)")
make_special_tests_table(doc)
spacer(doc, 4)

sub_bar(doc, "3F. Neurological Examination")
make_nerve_table(doc)
spacer(doc, 4)

# Additional neuro
make_two_col_table(doc, [
    ("Biceps reflex (C5/6):", "Normal / Reduced / Absent — Affected / Contralateral"),
    ("Brachioradialis reflex (C6):", "Normal / Reduced / Absent — Affected / Contralateral"),
    ("Triceps reflex (C7):", "Normal / Reduced / Absent — Affected / Contralateral"),
    ("Wrist drop present:", "Yes / No"),
    ("Finger / thumb extension loss:", "Yes / No"),
    ("Froment's sign:", "Positive / Negative"),
    ("Tinel's sign at medial epicondyle:", "Positive / Negative"),
    ("Elbow flexion test:", "Positive / Negative"),
    ("Cervical Spurling's test:", "Positive / Negative (exclude cervical root)"),
    ("Upper Limb Tension Test (ULTT):", "Positive / Negative"),
    ("Adson's maneuver (thoracic outlet):", "Positive / Negative"),
], col1_w=2.8, col2_w=4.5)
spacer(doc, 4)

sub_bar(doc, "3G. Vascular Examination")
make_two_col_table(doc, [
    ("Radial pulse — affected:", "Present / Absent / Diminished"),
    ("Radial pulse — contralateral:", "Present / Absent / Diminished"),
    ("Capillary refill time:", "< 2 sec / > 2 sec"),
    ("Skin colour / temperature:", "Normal / Pallor / Mottled / Cold"),
    ("Brachial pulse:", "Present / Absent"),
    ("Doppler required:", "Yes / No"),
], col1_w=2.8, col2_w=4.5)
spacer(doc, 6)

# ============================================================
# PART 4 — INVESTIGATIONS
# ============================================================
section_bar(doc, "PART 4 — INVESTIGATIONS")

sub_bar(doc, "4A. Imaging Requested")
items_img = [
    "AP X-ray (affected side)",
    "Lateral X-ray (affected side)",
    "AP X-ray (contralateral — for comparison)",
    "Lateral X-ray (contralateral)",
    "CT with 3D reconstruction",
    "MRI shoulder",
    "USS (rotator cuff assessment)",
    "CT angiogram",
]
make_check_table(doc, items_img, cols=4)
spacer(doc, 4)

sub_bar(doc, "4B. Radiographic Parameters (to complete after imaging)")
make_two_col_table(doc, [
    ("Neck-shaft angle (normal 130-140°):", "______°   Varus / Normal / Valgus"),
    ("Greater tuberosity position:", "Normal / Superior migration ____mm / Posteromedial"),
    ("Head retroversion (normal 20-30°):", "______°"),
    ("Angular deformity — shaft:", "Anterior / Posterior / Varus / Valgus — ______°"),
    ("Rotational deformity:", "Internal / External — ______°"),
    ("Shortening:", "______  mm"),
    ("Carrying angle (elbow):", "______°  Normal / Cubitus varus / Cubitus valgus"),
    ("Intra-articular involvement:", "Yes / No — site: _______________"),
    ("Hardware present:", "Yes / No — type: _______________"),
    ("Signs of osteonecrosis:", "None / Early collapse / Advanced"),
    ("Degenerative changes:", "None / Mild / Moderate / Severe"),
    ("Rotator cuff on MRI:", "Intact / Partial tear / Full thickness tear / Atrophy"),
], col1_w=2.8, col2_w=4.5)
spacer(doc, 4)

sub_bar(doc, "4C. Laboratory Investigations")
items_lab = [
    "FBC", "ESR", "CRP", "Blood cultures",
    "Bone profile (Ca, PO4, ALP)", "Vitamin D", "HbA1c",
    "Joint aspirate — MC&S", "Other: ___________",
]
make_check_table(doc, items_lab, cols=3)
spacer(doc, 6)

# ============================================================
# PART 5 — SUMMARY & PLAN
# ============================================================
section_bar(doc, "PART 5 — SUMMARY AND MANAGEMENT PLAN")

sub_bar(doc, "5A. Diagnosis / Impression")
tbl_dx = doc.add_table(rows=1, cols=1)
tbl_dx.style = "Table Grid"
tbl_dx.autofit = False
tbl_dx.columns[0].width = Inches(7.3)
cell = tbl_dx.rows[0].cells[0]
p = cell.paragraphs[0]
for _ in range(3):
    p.add_run("\n")
p.paragraph_format.space_before = Pt(4)
p.paragraph_format.space_after  = Pt(4)
spacer(doc, 4)

sub_bar(doc, "5B. Management Plan")
items_plan = [
    "Observation / watchful waiting",
    "Analgesia optimisation",
    "Physiotherapy / shoulder rehab programme",
    "Activity modification",
    "Subacromial corticosteroid injection",
    "Corrective osteotomy",
    "Rotator cuff repair / tuberosity osteotomy",
    "Reverse shoulder arthroplasty",
    "Hemiarthroplasty",
    "Nerve exploration / decompression",
    "Ulnar nerve transposition (tardy palsy)",
    "Further imaging / investigations",
    "Multidisciplinary team discussion",
    "Referral: ___________________________",
]
make_check_table(doc, items_plan, cols=2)
spacer(doc, 4)

sub_bar(doc, "5C. Follow-up & Notes")
tbl_notes = doc.add_table(rows=1, cols=1)
tbl_notes.style = "Table Grid"
tbl_notes.autofit = False
tbl_notes.columns[0].width = Inches(7.3)
cell_n = tbl_notes.rows[0].cells[0]
pn = cell_n.paragraphs[0]
for _ in range(5):
    pn.add_run("\n")
pn.paragraph_format.space_before = Pt(4)
pn.paragraph_format.space_after  = Pt(4)
spacer(doc, 4)

make_two_col_table(doc, [
    ("Follow-up appointment:", ""),
    ("Clinician signature:", ""),
], col1_w=2.8, col2_w=4.5)

spacer(doc, 6)

# ── Footer note ──────────────────────────────────────────────────────────────
p_foot = doc.add_paragraph()
p_foot.alignment = WD_ALIGN_PARAGRAPH.CENTER
r_foot = p_foot.add_run(
    "Based on Rockwood & Green's Fractures in Adults 10th Ed. | Campbell's Operative Orthopaedics 15th Ed. | "
    "Bailey & Love's Surgery 28th Ed.  |  Version 1.0 — July 2026"
)
r_foot.font.name = "Arial"
r_foot.font.size = Pt(7)
r_foot.font.color.rgb = RGBColor(0x88, 0x88, 0x88)

# ── Save ─────────────────────────────────────────────────────────────────────
out_path = "/tmp/workspace/humerus-malunion-proforma/Humerus_Malunion_Clinic_Proforma.docx"
doc.save(out_path)
print(f"Saved: {out_path}")