CASE PRESENTATION

ls /home/daytona/workspace/ && ls /home/daytona/skills/docx/

mkdir -p /home/daytona/workspace/periprosthetic-case && ls /home/daytona/workspa…

~/periprosthetic-case/create_case.js

const {
  Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
  HeadingLevel, AlignmentType, BorderStyle, WidthType, VerticalAlign,
  ShadingType, Header, Footer, PageNumber, NumberFormat
} = require('docx');
const fs = require('fs');

// Helper: bold paragraph
function boldPara(text, heading) {
  return new Paragraph({
    heading: heading || undefined,
    children: [new TextRun({ text, bold: true, font: 'Calibri' })]
  });
}

// Helper: normal paragraph
function normalPara(text, indent) {
  return new Paragraph({
    indent: indent ? { left: 720 } : undefined,
    children: [new TextRun({ text, font: 'Calibri', size: 22 })]
  });
}

// Helper: bullet
function bullet(text) {
  return new Paragraph({
    bullet: { level: 0 },
    children: [new TextRun({ text, font: 'Calibri', size: 22 })]
  });
}

// Helper: sub-bullet
function subbullet(text) {
  return new Paragraph({
    bullet: { level: 1 },
    children: [new TextRun({ text, font: 'Calibri', size: 22 })]
  });
}

function heading1(text) {
  return new Paragraph({
    heading: HeadingLevel.HEADING_1,
    children: [new TextRun({ text, bold: true, size: 28, color: '1F3864', font: 'Calibri' })]
  });
}

function heading2(text) {
  return new Paragraph({
    heading: HeadingLevel.HEADING_2,
    children: [new TextRun({ text, bold: true, size: 24, color: '2E75B6', font: 'Calibri' })]
  });
}

function heading3(text) {
  return new Paragraph({
    heading: HeadingLevel.HEADING_3,
    children: [new TextRun({ text, bold: true, size: 22, color: '404040', font: 'Calibri' })]
  });
}

function spacer() {
  return new Paragraph({ children: [new TextRun('')] });
}

function dividerPara() {
  return new Paragraph({
    border: { bottom: { style: BorderStyle.SINGLE, size: 6, color: '2E75B6' } },
    children: [new TextRun('')]
  });
}

// Patient details table
function patientTable() {
  const cellStyle = (text, bold) => new TableCell({
    width: { size: 25, type: WidthType.PERCENTAGE },
    shading: bold ? { type: ShadingType.SOLID, color: 'E7EEF8' } : undefined,
    children: [new Paragraph({ children: [new TextRun({ text, font: 'Calibri', size: 20, bold: !!bold })] })]
  });

  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({ children: [
        cellStyle('Name', true), cellStyle('Komal', false),
        cellStyle('CR No.', true), cellStyle('4753426', false)
      ]}),
      new TableRow({ children: [
        cellStyle('UID No.', true), cellStyle('3323442', false),
        cellStyle('Ward / Bed', true), cellStyle('Ortho Ward, Bed 23', false)
      ]}),
      new TableRow({ children: [
        cellStyle('Institution', true), cellStyle('SMIH, Dehradun', false),
        cellStyle('Date of Presentation', true), cellStyle('23/05/2026', false)
      ]}),
    ]
  });
}

// Measurements table
function measurementsTable() {
  const hCell = (text) => new TableCell({
    shading: { type: ShadingType.SOLID, color: '2E75B6' },
    children: [new Paragraph({ children: [new TextRun({ text, font: 'Calibri', size: 20, bold: true, color: 'FFFFFF' })] })]
  });
  const dCell = (text) => new TableCell({
    children: [new Paragraph({ children: [new TextRun({ text, font: 'Calibri', size: 20 })] })]
  });

  return new Table({
    width: { size: 70, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({ children: [hCell('Measurement'), hCell('Right (cm)'), hCell('Left (cm)')] }),
      new TableRow({ children: [dCell('Total Limb Length'), dCell('76'), dCell('80')] }),
      new TableRow({ children: [dCell('Femur Length'), dCell('36'), dCell('37')] }),
      new TableRow({ children: [dCell('Thigh Circumference'), dCell('29'), dCell('30')] }),
    ]
  });
}

const doc = new Document({
  styles: {
    default: {
      document: { run: { font: 'Calibri', size: 22 } }
    }
  },
  sections: [{
    properties: {
      page: {
        margin: { top: 1080, bottom: 1080, left: 1080, right: 1080 }
      }
    },
    headers: {
      default: new Header({
        children: [
          new Paragraph({
            alignment: AlignmentType.CENTER,
            border: { bottom: { style: BorderStyle.SINGLE, size: 6, color: '2E75B6' } },
            children: [
              new TextRun({ text: 'Shri Mahant Indiresh Hospital, Dehradun', bold: true, size: 20, color: '1F3864', font: 'Calibri' }),
              new TextRun({ text: '   |   ', size: 20, font: 'Calibri' }),
              new TextRun({ text: 'MS Orthopaedics - Final Professorial Examination', size: 20, italics: true, font: 'Calibri' }),
            ]
          })
        ]
      })
    },
    footers: {
      default: new Footer({
        children: [
          new Paragraph({
            alignment: AlignmentType.CENTER,
            border: { top: { style: BorderStyle.SINGLE, size: 6, color: '2E75B6' } },
            children: [
              new TextRun({ text: 'Case Presentation: Peri-Prosthetic Fracture after Right Hip Hemiarthroplasty   |   Page ', size: 18, font: 'Calibri', color: '666666' }),
              new TextRun({ children: [PageNumber.CURRENT], size: 18, font: 'Calibri', color: '666666' }),
            ]
          })
        ]
      })
    },
    children: [
      // Title
      new Paragraph({
        alignment: AlignmentType.CENTER,
        spacing: { before: 200, after: 100 },
        children: [
          new TextRun({ text: 'CASE PRESENTATION', bold: true, size: 36, color: '1F3864', font: 'Calibri' })
        ]
      }),
      new Paragraph({
        alignment: AlignmentType.CENTER,
        spacing: { after: 100 },
        children: [
          new TextRun({ text: 'Peri-Prosthetic Fracture of the Right Femur', bold: true, size: 28, color: '2E75B6', font: 'Calibri' })
        ]
      }),
      new Paragraph({
        alignment: AlignmentType.CENTER,
        spacing: { after: 300 },
        children: [
          new TextRun({ text: 'Following Right Hip Hemiarthroplasty (2022)', size: 24, italics: true, color: '404040', font: 'Calibri' })
        ]
      }),
      dividerPara(),
      spacer(),

      // Patient Details
      heading1('PATIENT DETAILS'),
      spacer(),
      patientTable(),
      spacer(),
      dividerPara(),
      spacer(),

      // Chief Complaints
      heading1('CHIEF COMPLAINTS'),
      bullet('Pain over the right hip region - following a traumatic event on 23/05/2026'),
      bullet('Inability to bear weight on the right lower limb'),
      spacer(),
      dividerPara(),
      spacer(),

      // HOPI
      heading1('HISTORY OF PRESENT ILLNESS'),
      new Paragraph({
        spacing: { before: 100 },
        children: [
          new TextRun({ text: 'The patient was ', font: 'Calibri', size: 22 }),
          new TextRun({ text: 'apparently asymptomatic prior to 23/05/2026', bold: true, font: 'Calibri', size: 22 }),
          new TextRun({ text: ', after which she sustained a ', font: 'Calibri', size: 22 }),
          new TextRun({ text: 'history of electrocution and burn injuries while grazing goats in a field near Tehri Garhwal', bold: true, font: 'Calibri', size: 22 }),
          new TextRun({ text: ' at approximately 2:30 PM. Following the electrocution, the patient had a mechanical fall.', font: 'Calibri', size: 22 }),
        ]
      }),
      spacer(),
      heading3('Nature of Pain:'),
      bullet('Location: Right hip region'),
      bullet('Onset: Acute, following the fall'),
      bullet('Character: Initially sharp and shooting'),
      bullet('Aggravating factors: Movement'),
      bullet('Relieving factors: Rest and analgesics'),
      bullet('Radiation: Non-referred, non-radiating'),
      bullet('Associated with diffuse swelling over the right hip initially - since subsided'),
      spacer(),
      heading3('Associated Complaints:'),
      bullet('Inability to bear weight on the right lower limb'),
      spacer(),
      heading3('Treatment Prior to Presentation:'),
      new Paragraph({
        children: [
          new TextRun({ text: 'The patient received initial treatment under the ', font: 'Calibri', size: 22 }),
          new TextRun({ text: 'Plastic Surgery Department', bold: true, font: 'Calibri', size: 22 }),
          new TextRun({ text: ' for electrical burns - necrotic tissue debridement was performed and ', font: 'Calibri', size: 22 }),
          new TextRun({ text: 'Silver Sulfadiazine (SSD) cream', bold: true, font: 'Calibri', size: 22 }),
          new TextRun({ text: ' was applied.', font: 'Calibri', size: 22 }),
        ]
      }),
      spacer(),
      heading3('Negative History:'),
      bullet('No history of fever'),
      bullet('No history of chronic illness'),
      bullet('No history of vomiting or seizures'),
      spacer(),
      dividerPara(),
      spacer(),

      // Past History
      heading1('PAST HISTORY'),
      spacer(),
      heading2('Surgical History'),
      new Paragraph({
        shading: { type: ShadingType.SOLID, color: 'FFF2CC' },
        spacing: { before: 100, after: 100 },
        indent: { left: 360 },
        children: [
          new TextRun({ text: 'KEY: Underwent Hemiarthroplasty of the Right Hip in 2022', bold: true, size: 22, color: '7F6000', font: 'Calibri' }),
          new TextRun({ text: ' - Current presentation represents a peri-prosthetic fracture around this implant.', size: 22, color: '7F6000', font: 'Calibri', italics: true }),
        ]
      }),
      spacer(),
      heading2('Medical History'),
      bullet('No history of Hypertension'),
      bullet('No history of Diabetes Mellitus'),
      bullet('No history of COPD'),
      bullet('No history of CAD'),
      spacer(),
      heading2('Personal History'),
      bullet('No history of alcohol or drug abuse'),
      bullet('Known bidi smoker - approximately 1 packet per week'),
      spacer(),
      heading2('Family History'),
      normalPara('Not significant'),
      spacer(),
      heading2('Drug History'),
      normalPara('Not significant'),
      spacer(),
      heading2('Allergic History'),
      normalPara('Not significant'),
      spacer(),
      dividerPara(),
      spacer(),

      // General Examination
      heading1('GENERAL EXAMINATION'),
      bullet('General Condition: Fair'),
      bullet('Pallor / Icterus / Clubbing / Cyanosis / Lymphadenopathy / Edema: NAD'),
      bullet('CNS: No neurological deficit; conscious, oriented to time, place and person'),
      bullet('CVS: S1 and S2 heard, normal heart sounds'),
      bullet('Per Abdomen (P/A): Within normal limits, no organomegaly'),
      bullet('Respiratory System (R/S): Normal vesicular breath sounds, bilaterally equal'),
      spacer(),
      dividerPara(),
      spacer(),

      // Local Examination
      heading1('LOCAL EXAMINATION - RIGHT HIP'),
      spacer(),
      heading2('Attitude'),
      bullet('Right lower limb in external rotation'),
      spacer(),
      heading2('Inspection'),
      bullet('Old healed surgical scar (~15 cm) over the posterolateral aspect of the right thigh - consistent with prior hemiarthroplasty approach'),
      bullet('No visible swelling over the right hip'),
      bullet('No visible bony deformity over the right hip region'),
      bullet('No sinus / ecchymosis present'),
      spacer(),
      heading2('Palpation'),
      bullet('Local temperature: Not raised compared to the opposite side'),
      bullet('No palpable swelling over the right hip'),
      bullet('Tenderness on deep palpation over the right hip joint'),
      bullet('No palpable bony deformity over the right hip'),
      bullet('No bony gaps felt over the right hip region'),
      spacer(),
      heading2('Range of Motion (ROM)'),
      bullet('Painful and restricted over the right hip joint in all planes'),
      spacer(),
      heading2('Distal Neurovascular Status (DNVS)'),
      bullet('Distal pulses (DP, PT): Palpable'),
      bullet('Active toe movements: Present'),
      bullet('Motor function: Intact'),
      bullet('Sensory function: Intact'),
      spacer(),
      heading2('Limb Measurements'),
      spacer(),
      measurementsTable(),
      spacer(),
      new Paragraph({
        shading: { type: ShadingType.SOLID, color: 'FFE0E0' },
        indent: { left: 360 },
        children: [
          new TextRun({ text: 'Note: 4 cm shortening of the right lower limb - consistent with peri-prosthetic fracture with proximal migration or implant subsidence.', bold: true, size: 22, color: 'C00000', font: 'Calibri' })
        ]
      }),
      spacer(),
      dividerPara(),
      spacer(),

      // Provisional Diagnosis
      heading1('PROVISIONAL DIAGNOSIS'),
      new Paragraph({
        shading: { type: ShadingType.SOLID, color: 'E2F0D9' },
        spacing: { before: 100, after: 100 },
        indent: { left: 360, right: 360 },
        children: [
          new TextRun({ text: 'Peri-prosthetic fracture of the right femur following right hip hemiarthroplasty (2022), sustained following an electrocution-induced fall near Tehri Garhwal on 23/05/2026.', bold: true, size: 24, color: '375623', font: 'Calibri' })
        ]
      }),
      new Paragraph({
        indent: { left: 360 },
        children: [
          new TextRun({ text: 'Likely Vancouver Type B fracture - subtype to be confirmed on radiological assessment.', italics: true, size: 22, font: 'Calibri', color: '375623' })
        ]
      }),
      spacer(),
      dividerPara(),
      spacer(),

      // Discussion points
      heading1('POINTS TO DISCUSS IN PRESENTATION'),
      spacer(),
      heading2('1. Vancouver Classification of Peri-Prosthetic Hip Fractures'),
      bullet('Type A - Trochanteric region'),
      subbullet('AG = Greater trochanter'),
      subbullet('AL = Lesser trochanter'),
      bullet('Type B - Around or below the stem'),
      subbullet('B1 - Stem well fixed, good bone stock -> ORIF'),
      subbullet('B2 - Stem loose, good bone stock -> Revision with long stem'),
      subbullet('B3 - Stem loose, poor bone stock -> Revision with structural graft / megaprosthesis'),
      bullet('Type C - Well below the stem tip -> Standard ORIF with locking plate'),
      spacer(),
      heading2('2. Mechanism'),
      new Paragraph({
        children: [new TextRun({ text: 'Electrocution causing muscle tetany/spasm followed by a fall - indirect force on a femur already weakened around an existing prosthesis. Post-electrocution rhabdomyolysis may further compromise bone/muscle.', font: 'Calibri', size: 22 })]
      }),
      spacer(),
      heading2('3. Investigations Required'),
      bullet('X-ray: AP pelvis + AP/Lateral right femur full length (must include the implant tip)'),
      bullet('CT scan: If needed to assess bone quality, fracture pattern and implant fixity'),
      bullet('Routine bloods: CBC, RFT, LFT, blood sugar, coagulation profile (pre-op workup)'),
      bullet('ECG: Post-electrocution cardiac monitoring'),
      bullet('Serum CPK / Urine myoglobin: Screen for rhabdomyolysis post-electrocution'),
      spacer(),
      heading2('4. Management Principles'),
      bullet('Vancouver B1: ORIF with cortical strut grafts + cable plate or locking plate, stem retained'),
      bullet('Vancouver B2: Revision hemiarthroplasty with long-stem cemented or cementless prosthesis'),
      bullet('Vancouver B3: Revision with structural allograft + long stem or proximal femoral replacement'),
      bullet('Vancouver C: Standard ORIF with locking plate'),
      spacer(),
      heading2('5. Key Differentials'),
      bullet('Dislocation of hemiarthroplasty (no limb shortening, femoral head not in acetabulum on X-ray)'),
      bullet('Implant loosening / subsidence without acute fracture'),
      bullet('Periprosthetic joint infection (absent here - no fever, no raised local temperature)'),
      spacer(),
      dividerPara(),
      spacer(),

      // Summary
      heading1('SUMMARY FOR VIVA'),
      new Paragraph({
        shading: { type: ShadingType.SOLID, color: 'EDF2F8' },
        indent: { left: 360, right: 360 },
        spacing: { before: 200, after: 200 },
        children: [
          new TextRun({
            text: '"This is a case of Mrs. Komal, who underwent right hip hemiarthroplasty in 2022 and presents now with acute pain and inability to bear weight on the right lower limb following an electrocution and fall on 23/05/2026. Examination reveals external rotation attitude of the right lower limb, tenderness on deep palpation of the right hip, restricted and painful range of motion, and a 4 cm shortening of the right lower limb compared to the left. There is an old healed posterolateral surgical scar consistent with the prior hemiarthroplasty. Distal neurovascular status is intact. The clinical picture is consistent with a peri-prosthetic fracture around the right hip hemiarthroplasty, most likely a Vancouver Type B fracture, the subtype of which will be determined by full-length AP and lateral femur radiographs with assessment of stem fixity."',
            italics: true, size: 22, font: 'Calibri', color: '1F3864'
          })
        ]
      }),
      spacer(),
      dividerPara(),
      spacer(),

      // Examiner tip
      new Paragraph({
        shading: { type: ShadingType.SOLID, color: 'FFF2CC' },
        indent: { left: 360, right: 360 },
        spacing: { before: 100, after: 100 },
        children: [
          new TextRun({ text: 'EXAMINER TIP: ', bold: true, size: 22, color: '7F6000', font: 'Calibri' }),
          new TextRun({ text: 'Be prepared to show and interpret the AP pelvis X-ray alongside the full-length femur film. Know the Vancouver classification thoroughly - examiners at the Final Prof invariably ask you to classify on the X-ray and justify your management plan based on stem fixity and bone stock assessment.', size: 22, color: '7F6000', font: 'Calibri' })
        ]
      }),
    ]
  }]
});

Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync('/home/daytona/workspace/periprosthetic-case/Komal_PeriProsthetic_Case_Presentation.docx', buffer);
  console.log('Document created successfully.');
});

cd /home/daytona/workspace/periprosthetic-case && node create_case.js

python /home/daytona/skills/docx/scripts/office/validate.py /home/daytona/worksp…

cd /home/daytona/workspace/periprosthetic-case && python -c " import zipfile, os…