ls /home/daytona/workspace/ 2>/dev/null || echo "workspace empty"

mkdir -p /home/daytona/workspace/elderly-fractures-ppt

~/elderly-fractures-ppt/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Common Fractures in the Elderly";
pres.author = "Orris Medical Education";

// ─── THEME ───────────────────────────────────────────────────────────────────
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// ─── HELPERS ─────────────────────────────────────────────────────────────────
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// ═══════════════════════════════════════════════════════════════════════════════
//  SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════════════════
{
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// ═══════════════════════════════════════════════════════════════════════════════
//  SLIDE 2 — AGENDA / OUTLINE
// ═══════════════════════════════════════════════════════════════════════════════
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  const sections = [
    { num: "01", title: "Why Fractures Matter in the Elderly", sub: "Epidemiology & burden of disease" },
    { num: "02", title: "Identification & Diagnosis", sub: "Clinical features, imaging, classification" },
    { num: "03", title: "Functional Changes", sub: "Physiological impact, osteoporosis, bone biology" },
    { num: "04", title: "Acute Care & Stabilization", sub: "Emergency assessment & initial management" },
    { num: "05", title: "Common Fracture Types & Management", sub: "Hip, vertebral, Colles', proximal humerus, ankle" },
    { num: "06", title: "Rehabilitation", sub: "Goals, physiotherapy, multidisciplinary approach" },
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// ═══════════════════════════════════════════════════════════════════════════════
//  SECTION 1 DIVIDER
// ═══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  sectionDivider(slide, "01", "Why Fractures Matter\nin the Elderly", "Epidemiology & burden of disease");
}

// ═══════════════════════════════════════════════════════════════════════════════
//  SLIDE 3 — EPIDEMIOLOGY
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Epidemiology of Fractures in the Elderly",
  [
    "Over 300,000 hip fracture hospitalizations occur annually in the United States alone (Barash et al., Clinical Anesthesia 9e)",
    "Worldwide incidence expected to reach 6.3 million hip fractures per year by 2050 due to aging populations",
    "1-year mortality after hip fracture: 20-30%; survivors face significant disability and loss of independence",
    "Women account for ~75% of hip fractures due to postmenopausal osteoporosis (earlier onset, greater bone loss)",
    "A trochanteric hip fracture may be the first sign of frailty in the elderly (Rockwood & Green's, 2025)",
    "Fragility fractures defined as fractures caused by forces insufficient to break normal bone - typically a fall from standing height",
    "Most non-vertebral fractures are triggered by a fall; vertebral fractures may occur spontaneously",
    "Fractures carry major socioeconomic cost: prolonged hospitalizations, nursing home placement, loss of productivity",
  ],
  "Section 01 — Epidemiology"
);

// ═══════════════════════════════════════════════════════════════════════════════
//  SECTION 2 DIVIDER
// ═══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  sectionDivider(slide, "02", "Identification\n& Diagnosis", "Clinical features, imaging, classification");
}

// ═══════════════════════════════════════════════════════════════════════════════
//  SLIDE — CLINICAL IDENTIFICATION
// ═══════════════════════════════════════════════════════════════════════════════
twoColSlide(
  "Clinical Identification of Fractures",
  {
    title: "History & Symptoms",
    items: [
      "Mechanism: fall from standing height (fragility fracture), minor trauma or spontaneous",
      "Pain at fracture site, often sudden onset",
      "Inability to weight-bear (lower limb fractures)",
      "Acute back pain (vertebral fracture)",
      "Deformity of wrist after fall on outstretched hand (Colles')",
      "Shoulder pain + restricted movement (proximal humerus)",
      "Height loss and kyphosis (multiple vertebral fractures)",
    ],
  },
  {
    title: "Physical Examination",
    items: [
      "Limb shortening and external rotation: classic hip fracture sign",
      "Tenderness over fracture site",
      "Dinner-fork deformity of wrist: Colles' fracture",
      "Loss of normal wrist concavity",
      "Radial styloid at same level or higher than ulnar styloid",
      "Swelling, bruising, crepitus",
      "Neurovascular assessment distal to fracture (mandatory)",
    ],
  },
  "Section 02 — Identification"
);

// ─── imaging & classification ─────────────────────────────────────────────────
contentSlide(
  "Imaging & Classification",
  [
    { head: "Plain X-ray (first-line):", body: "AP and lateral views of the affected site; identifies fracture line, displacement, angulation. Radial styloid at same level or higher than ulnar styloid in Colles' fracture." },
    { head: "CT Scan:", body: "Preferred for occult fractures, acetabular fractures, sacral fractures, and surgical planning. Required when plain film is negative but clinical suspicion is high." },
    { head: "MRI:", body: "Gold standard for occult hip fractures (stress fractures not visible on X-ray); also shows bone marrow edema and soft tissue injuries." },
    { head: "DEXA Scan:", body: "Measures bone mineral density (BMD). T-score < -2.5 = osteoporosis; T-score -1.0 to -2.5 = osteopenia. Indicated post-fracture in patients ≥50 years (fracture liaison service model)." },
    { head: "FRAX Calculator:", body: "Estimates 10-year probability of major osteoporotic fracture using clinical risk factors ± BMD. Guides treatment decisions (www.shef.ac.uk/frax/)." },
    { head: "Garden Classification (femoral neck):", body: "Grades I-IV by degree of displacement. Grade I-II = undisplaced (ORIF); Grade III-IV = displaced (arthroplasty in elderly)." },
    { head: "AO/OTA Classification:", body: "Universal fracture classification system used for surgical planning and research." },
  ],
  "Section 02 — Identification"
);

// ═══════════════════════════════════════════════════════════════════════════════
//  SECTION 3 DIVIDER
// ═══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  sectionDivider(slide, "03", "Functional Changes", "Physiological impact of fractures in aging bone");
}

// ─── functional / physiological changes ──────────────────────────────────────
twoColSlide(
  "Functional Changes in Elderly Bone",
  {
    title: "Bone Biology Changes",
    items: [
      "Bone mass peaks at age ~30; progressive loss thereafter",
      "Postmenopausal women: accelerated loss due to estrogen deficiency",
      "Reduced osteoblast activity, increased osteoclast dominance",
      "Cortical thinning and trabecular rarefaction",
      "Impaired fracture healing due to reduced vascularity and cellular response",
      "Osteoporosis (T-score < -2.5): skeletal fragility with increased fracture risk (Rockwood & Green's, 2025)",
    ],
  },
  {
    title: "Systemic Functional Impact",
    items: [
      "Immobility leads to rapid muscle atrophy (sarcopenia accelerates)",
      "Deep vein thrombosis (DVT) and pulmonary embolism risk elevated",
      "Pressure ulcers from prolonged bed rest",
      "Delirium and cognitive decline in elderly hospital patients",
      "Respiratory compromise from vertebral fractures and kyphosis",
      "Abdominal discomfort from reduced thoracoabdominal volume",
      "Loss of independence: most significant long-term consequence",
    ],
  },
  "Section 03 — Functional Changes"
);

// ─── osteoporosis risk factors ────────────────────────────────────────────────
contentSlide(
  "Risk Factors for Osteoporotic Fractures",
  [
    { head: "Non-modifiable:", body: "Age, female sex, postmenopausal status, family history of fragility fracture, White/Asian ethnicity, prior fracture history" },
    { head: "Lifestyle:", body: "Sedentary lifestyle (immobility causes bone loss), smoking (accelerated menopause, impaired estrogen metabolism), alcohol >3 units/day, low calcium diet, heavy cannabis use" },
    { head: "Comorbidities:", body: "Hypogonadism, rheumatoid arthritis, primary hyperparathyroidism, Cushing syndrome, chronic liver/renal disease, inflammatory bowel disease, epilepsy" },
    { head: "Medications:", body: "Corticosteroids (most common drug cause), thyroxine, GnRH agonists, sedatives, anticonvulsants" },
    { head: "Falls risk:", body: "Poor vision, balance disorders, Parkinson's disease, lower limb weakness, polypharmacy (sedatives, antihypertensives), environmental hazards" },
    { head: "Biochemical markers:", body: "Low serum calcium, vitamin D deficiency, elevated parathyroid hormone (PTH), elevated bone turnover markers (CTX, P1NP)" },
  ],
  "Section 03 — Functional Changes"
);

// ═══════════════════════════════════════════════════════════════════════════════
//  SECTION 4 DIVIDER
// ═══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  sectionDivider(slide, "04", "Acute Care &\nStabilization", "Emergency assessment and initial management");
}

// ─── acute care ───────────────────────────────────────────────────────────────
contentSlide(
  "Acute Care & Initial Stabilization",
  [
    { head: "Primary Survey (ABCDE):", body: "Airway, breathing, circulation - exclude haemodynamic instability. High-energy trauma or pathological fracture: full trauma protocol." },
    { head: "Pain Management:", body: "IV/IM analgesia (paracetamol, NSAIDs with caution in elderly, opioids titrated carefully). Nerve blocks (femoral, fascia iliaca) provide excellent hip fracture analgesia with fewer systemic effects." },
    { head: "Neurovascular Assessment:", body: "Distal pulses, capillary refill, sensation and motor function distal to fracture - document before and after any manipulation." },
    { head: "Immobilization:", body: "Splinting and traction for long bone fractures to reduce pain and blood loss. Cervical fractures: rigid collar, spinal precautions. Avoid prolonged traction in elderly (pressure areas, delirium risk)." },
    { head: "Investigations:", body: "FBC, U&E, creatinine, LFTs, coagulation, group & save, ECG, CXR, imaging of fracture. Cross-match if significant haemorrhage expected." },
    { head: "Timing to Surgery:", body: "Delays >48 hrs to surgery for hip fractures increase mortality significantly (McGuire et al., 2004; Moran et al., 2005). Target surgery within 24-48 hours after medical optimization." },
    { head: "Medical Optimization:", body: "Anticoagulation management, cardiac assessment, fluid resuscitation, electrolyte correction, review of medications (antiplatelet/anticoagulant bridging decisions)." },
  ],
  "Section 04 — Acute Care"
);

// ─── multidisciplinary table ──────────────────────────────────────────────────
tableSlide(
  "Multidisciplinary Team in Acute Fracture Care",
  ["Specialty / Role", "Key Contribution", "Timing"],
  [
    ["Orthopaedic Surgeon", "Fracture reduction and fixation, surgical decision-making", "Acute & intraoperative"],
    ["Geriatrician / Internist", "Medical co-management, comorbidity optimization, delirium prevention", "Pre-op through discharge"],
    ["Anaesthesiologist", "Perioperative risk stratification, regional vs. general anaesthesia choice", "Pre-op & intraoperative"],
    ["Emergency Medicine", "Primary assessment, resuscitation, initial imaging", "Acute ED phase"],
    ["Physiotherapist", "Early mobilization, gait retraining, exercise prescription", "Post-op Day 1 onwards"],
    ["Occupational Therapist", "ADL assessment, home modification, adaptive equipment", "Rehabilitation phase"],
    ["Social Worker", "Discharge planning, carer support, nursing home liaison", "Early & at discharge"],
    ["Fracture Liaison Nurse", "Osteoporosis investigation, secondary fracture prevention", "Post-acute & follow-up"],
  ],
  "Section 04 — Acute Care"
);

// ═══════════════════════════════════════════════════════════════════════════════
//  SECTION 5 DIVIDER
// ═══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  sectionDivider(slide, "05", "Common Fracture Types\n& Management", "Hip, vertebral, wrist, humerus, ankle");
}

// ─── HIP FRACTURE ─────────────────────────────────────────────────────────────
twoColSlide(
  "Hip Fracture — Femoral Neck & Intertrochanteric",
  {
    title: "Femoral Neck Fractures",
    items: [
      "Intracapsular; blood supply at risk (medial circumflex femoral artery)",
      "Garden Classification I-IV; displaced = arthroplasty preferred in elderly",
      "Undisplaced (Garden I-II): internal fixation with cannulated screws or dynamic hip screw (DHS)",
      "Displaced (Garden III-IV): hemiarthroplasty (cemented) or total hip arthroplasty in active patients",
      "Complications: AVN, non-union, periprosthetic fracture",
      "Cemented hemiarthroplasty preferred in elderly - reduces periprosthetic fracture risk vs. uncemented",
    ],
  },
  {
    title: "Intertrochanteric Fractures",
    items: [
      "Extracapsular; blood supply usually preserved, lower AVN risk",
      "AO classification based on stability",
      "Standard treatment: cephalomedullary nail (e.g., proximal femoral nail - PFN) or dynamic hip screw",
      "Cephalomedullary nail preferred for unstable, reverse oblique, and subtrochanteric patterns",
      "Early mobilization key: weight-bearing as tolerated from Day 1 post-op",
      "Outcomes: return to ambulatory status in ~50% after hip fracture (Mariconda et al., 2016)",
    ],
  },
  "Section 05 — Fracture Types"
);

// ─── VERTEBRAL FRACTURE ───────────────────────────────────────────────────────
contentSlide(
  "Vertebral Compression Fractures",
  [
    { head: "Epidemiology:", body: "Most common osteoporotic fracture; many are asymptomatic and detected incidentally. Often thoracic (T12) or thoracolumbar junction (L1)." },
    { head: "Clinical Presentation:", body: "Acute back pain (localized or radiating to anterior chest/abdomen), or insidious height loss + kyphosis. May mimic cardiac, pulmonary or abdominal pathology." },
    { head: "Diagnosis:", body: "Plain X-ray first: look for anterior wedging, height loss >20%. CT for detail. MRI to assess acuity (bone marrow edema indicates acute fracture) and exclude neurological compromise." },
    { head: "Conservative Management:", body: "Analgesia (paracetamol, short-course opioids), bracing (Jewett hyperextension brace), early mobilization, calcium + vitamin D, anti-osteoporotic therapy." },
    { head: "Vertebroplasty / Kyphoplasty:", body: "Percutaneous cement augmentation for acute painful vertebral fractures not responding to conservative care. Kyphoplasty uses a balloon to restore height before cement injection. Evidence for long-term benefit remains debated." },
    { head: "Neurological Compromise:", body: "Urgent surgical decompression + stabilization if spinal cord/cauda equina compression. May require anterior, posterior or combined approach." },
    { head: "Long-term:", body: "Each vertebral fracture increases risk of subsequent fracture 3-5 fold. Initiate bisphosphonates, denosumab, or teriparatide per DEXA/FRAX assessment." },
  ],
  "Section 05 — Fracture Types"
);

// ─── COLLES' FRACTURE ─────────────────────────────────────────────────────────
twoColSlide(
  "Colles' Fracture (Distal Radius)",
  {
    title: "Identification",
    items: [
      "Most common fracture in elderly women; caused by fall on outstretched hand with supination force",
      "Due to osteoporosis in postmenopausal women - brittle distal radial metaphysis (Tintinalli's EM)",
      "Fracture ~2 cm proximal to distal articular surface of radius",
      "Distal fragment: displaced dorsally, proximally, laterally + angulated backwards",
      "Dinner-fork deformity of wrist (dorsal prominence)",
      "Loss of anterior concavity of radius; radial styloid at same level or higher than ulnar styloid",
    ],
  },
  {
    title: "Management",
    items: [
      "Undisplaced: plaster slab in slight palmar flexion and ulnar deviation for 5-6 weeks",
      "Displaced: closed reduction under haematoma block/Bier's block + plaster",
      "Acceptable reduction: <10° dorsal tilt, <2mm articular step, <3mm radial shortening",
      "Surgical (ORIF with volar locking plate): comminuted, intra-articular, unstable, failed conservative",
      "Complications: mal-union (most common), Sudeck's osteodystrophy (CRPS), EPL tendon rupture, median nerve compression (carpal tunnel), manus valgus, stiffness",
      "Physiotherapy from week 1: finger exercises, elevation; wrist ROM after immobilization",
    ],
  },
  "Section 05 — Fracture Types"
);

// ─── PROXIMAL HUMERUS ─────────────────────────────────────────────────────────
contentSlide(
  "Proximal Humerus Fracture",
  [
    { head: "Epidemiology:", body: "Third most common osteoporotic fracture (after hip and vertebra). Typically elderly women after low-energy fall." },
    { head: "Neer Classification:", body: "Based on 4 parts (head, greater tuberosity, lesser tuberosity, shaft) and displacement. 1-part (non-displaced): majority (80%); 2-part, 3-part, 4-part with increasing complexity and AVN risk." },
    { head: "Non-surgical (majority):", body: "Sling immobilization for 3-4 weeks, pendulum exercises early, progressive physiotherapy. Suitable for most 1-part and many 2-part fractures." },
    { head: "Surgical Indications:", body: "Significantly displaced 3- and 4-part fractures, vascular injury, failed conservative. ORIF with locking plate for younger patients; reverse total shoulder arthroplasty preferred for elderly with 4-part fractures." },
    { head: "Complications:", body: "AVN of the humeral head (especially 4-part), malunion, rotator cuff damage, subacromial impingement, axillary nerve injury (test deltoid sensation)." },
    { head: "Rehabilitation:", body: "Physiotherapy begins within 1-2 weeks of injury/surgery. Goals: restore ROM, shoulder strength, and functional overhead activities." },
  ],
  "Section 05 — Fracture Types"
);

// ─── ANKLE FRACTURE ───────────────────────────────────────────────────────────
contentSlide(
  "Ankle Fracture in the Elderly",
  [
    { head: "Epidemiology:", body: "Increasing incidence with age; often due to low-energy twist or fall. Associated with osteoporosis and poor bone quality." },
    { head: "Classification:", body: "Weber (A/B/C) based on fibula fracture level relative to mortise; Lauge-Hansen based on mechanism. Bimalleolar or trimalleolar in elderly due to poor bone quality." },
    { head: "Clinical Signs:", body: "Pain, swelling, inability to weight-bear, deformity. Ottawa Ankle Rules guide imaging decision." },
    { head: "Non-surgical:", body: "Stable undisplaced lateral malleolus (Weber A/B): below-knee plaster or boot, 6 weeks. Early mobilization if stable." },
    { head: "Surgical (ORIF):", body: "Displaced, bimalleolar, trimalleolar, or unstable fractures. Plate-and-screw fixation. Wound healing complications increased in elderly with diabetes, poor vascularity - careful surgical technique essential." },
    { head: "Complications:", body: "Wound dehiscence and infection (especially diabetics), malunion, post-traumatic arthritis, DVT. Consider perioperative DVT prophylaxis in all elderly patients." },
    { head: "Rehabilitation:", body: "Non-weight-bearing initially, progression to weight-bearing per fixation stability. Physiotherapy: ankle ROM, strengthening, proprioception, gait retraining." },
  ],
  "Section 05 — Fracture Types"
);

// ─── FRACTURE COMPARISON TABLE ────────────────────────────────────────────────
tableSlide(
  "Summary: Common Fractures in the Elderly",
  ["Fracture", "Classic Mechanism", "Key Sign", "1st-line Treatment", "Key Complication"],
  [
    ["Hip (Femoral Neck)", "Fall, osteoporosis", "Short + externally rotated leg", "Hemi/THA (displaced), DHS (undisplaced)", "AVN, non-union, mortality"],
    ["Intertrochanteric Hip", "Fall, osteoporosis", "Same as above", "Cephalomedullary nail / DHS", "Loss of fixation, leg shortening"],
    ["Vertebral Compression", "Minimal/spontaneous", "Back pain, kyphosis, height loss", "Analgesia, brace, OP treatment", "Further VCF, neurological deficit"],
    ["Colles' (Distal Radius)", "FOOSH + supination", "Dinner-fork deformity", "Reduction + plaster / ORIF", "Malunion, CRPS, EPL rupture"],
    ["Proximal Humerus", "Fall, arm outstretched", "Shoulder pain, bruising", "Sling (80%) / ORIF / Arthroplasty", "AVN, stiffness, malunion"],
    ["Ankle", "Twisting, fall", "Swelling, deformity", "Plaster / ORIF", "Wound infection, post-traumatic OA"],
  ],
  "Section 05 — Fracture Types"
);

// ═══════════════════════════════════════════════════════════════════════════════
//  SECTION 6 DIVIDER
// ═══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  sectionDivider(slide, "06", "Rehabilitation", "Goals, physiotherapy, multidisciplinary approach");
}

// ─── rehabilitation principles ────────────────────────────────────────────────
twoColSlide(
  "Rehabilitation Principles in Elderly Fracture Patients",
  {
    title: "Goals of Rehabilitation",
    items: [
      "Restore pre-fracture level of function and independence",
      "Prevent secondary complications (DVT, pneumonia, pressure sores, delirium)",
      "Maximize mobility and gait safety",
      "Reduce risk of recurrent falls and fractures",
      "Maintain or improve cognitive function",
      "Support return to community living",
      "Patient and carer education",
    ],
  },
  {
    title: "Physiotherapy Interventions",
    items: [
      "Early mobilization: commence Day 1 post-operatively (hip/ankle fractures)",
      "Progressive weight-bearing as tolerated with walking aids",
      "Proprioception and balance training",
      "Strengthening exercises: quadriceps, hip abductors, core",
      "Upper limb ROM for Colles' and proximal humerus fractures",
      "Falls prevention exercise programs (Otago, FAME programs - RCT evidence)",
      "Aquatic therapy and low-impact aerobic conditioning",
    ],
  },
  "Section 06 — Rehabilitation"
);

// ─── secondary fracture prevention ───────────────────────────────────────────
contentSlide(
  "Secondary Fracture Prevention & Long-term Management",
  [
    { head: "Fracture Liaison Service (FLS):", body: "Systematic identification and treatment of patients ≥50 years with fragility fractures. Implementation increases investigation rate from ~10% to >90% (Rockwood & Green's). Cost-effective in reducing fracture burden." },
    { head: "Calcium + Vitamin D:", body: "Supplement all patients: Calcium 1000-1200 mg/day + Vitamin D 800-1000 IU/day. Correct deficiency before starting anti-resorptive therapy." },
    { head: "Anti-resorptive Therapy:", body: "Bisphosphonates (alendronate, risedronate, zoledronic acid - annual IV) are first-line. Denosumab (6-monthly SC injection) for patients intolerant of or unsuitable for bisphosphonates." },
    { head: "Anabolic Therapy:", body: "Teriparatide (PTH analog) or romosozumab for very high-risk patients, multiple vertebral fractures, or inadequate response to anti-resorptives." },
    { head: "Falls Prevention:", body: "Home hazard assessment, footwear modification, medication review (reduce sedatives/antihypertensives), vision correction, hip protectors." },
    { head: "Nutrition:", body: "Adequate protein intake, address malnutrition (common in elderly). Nutritional supplementation reduces complications and mortality post-hip fracture." },
    { head: "Follow-up:", body: "DEXA 18-24 months after starting treatment; monitor biochemical markers of bone turnover (CTX, P1NP) to confirm medication adherence and response." },
  ],
  "Section 06 — Rehabilitation"
);

// ─── rehabilitation pathway ───────────────────────────────────────────────────
{
  const slide = pres.addSlide();
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  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: C.teal }, line: { type: "none" } });
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  slide.addShape(pres.ShapeType.rect, { x: 0.12, y: 0.18, w: 9.88, h: 0.72, fill: { color: C.navy }, line: { type: "none" } });
  slide.addText("Hip Fracture Rehabilitation Pathway", { x: 0.35, y: 0.18, w: 9.5, h: 0.72, fontSize: 18, bold: true, color: C.white, fontFace: FONT, valign: "middle" });

  const phases = [
    { phase: "Pre-op\n(Day 0)", items: ["Analgesia + nerve block", "Fluid resuscitation", "Medical optimization", "Consent + patient education"] },
    { phase: "Post-op\nDay 1-2", items: ["Sit out of bed", "Commence physiotherapy", "Weight-bearing as tolerated", "DVT prophylaxis"] },
    { phase: "Inpatient\nDay 3-7", items: ["Walk with frame/crutches", "Occupational therapy ADL", "Wound check", "Nutrition review"] },
    { phase: "Subacute\nWeek 2-6", items: ["Rehab ward or community", "Progressive gait training", "Stair practice", "Falls assessment"] },
    { phase: "Long-term\n3-6 months", items: ["Return to premorbid function", "Osteoporosis treatment", "FLS follow-up", "DEXA at 12-18 months"] },
  ];

  phases.forEach((p, i) => {
    const x = 0.2 + i * 1.95;
    slide.addShape(pres.ShapeType.rect, { x, y: 1.1, w: 1.78, h: 4.15, fill: { color: i % 2 === 0 ? C.lightBg : C.offWhite }, line: { color: C.teal, pt: 0.5 } });
    slide.addShape(pres.ShapeType.rect, { x, y: 1.1, w: 1.78, h: 0.6, fill: { color: i % 2 === 0 ? C.teal : C.navy }, line: { type: "none" } });
    slide.addText(p.phase, { x, y: 1.1, w: 1.78, h: 0.6, fontSize: 10, bold: true, color: C.white, fontFace: FONT, align: "center", valign: "middle" });
    const items = p.items.map((t, ti) => ({ text: t, options: { bullet: { color: C.gold }, color: C.text, fontSize: 10, fontFace: FONT, breakLine: ti < p.items.length - 1 } }));
    slide.addText(items, { x: x + 0.08, y: 1.75, w: 1.62, h: 3.35, valign: "top", margin: 2, paraSpaceAfter: 4 });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
//  SLIDE — KEY TAKE-HOMES
// ═══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy }, line: { type: "none" } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: C.gold }, line: { type: "none" } });
  slide.addText("Key Take-Home Messages", { x: 0.35, y: 0.2, w: 9.3, h: 0.65, fontSize: 22, bold: true, color: C.gold, fontFace: FONT });

  const msgs = [
    "Hip fractures carry 20-30% 1-year mortality - time to surgery <48 hours significantly reduces this",
    "Every elderly fragility fracture is a sign of osteoporosis until proven otherwise - investigate and treat",
    "Colles' fracture = classic dinner-fork deformity; most are managed conservatively but unstable patterns need ORIF",
    "Vertebral fractures can mimic cardiac and abdominal pathology - maintain clinical vigilance",
    "Early mobilization (Day 1 post-op) is the single most impactful rehabilitation intervention for hip fractures",
    "Multidisciplinary care (orthogeriatric model) reduces mortality, delirium, and hospital length of stay",
    "Secondary fracture prevention via the Fracture Liaison Service prevents the 'second fracture epidemic'",
  ];

  msgs.forEach((m, i) => {
    const y = 0.95 + i * 0.63;
    slide.addShape(pres.ShapeType.rect, { x: 0.3, y: y + 0.08, w: 0.35, h: 0.35, fill: { color: C.gold }, line: { type: "none" }, rounding: 0.5 });
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    slide.addText(m, { x: 0.78, y, w: 8.9, h: 0.55, fontSize: 11.5, color: C.white, fontFace: FONT, valign: "middle" });
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}

// ═══════════════════════════════════════════════════════════════════════════════
//  SLIDE — REFERENCES
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Key References",
  [
    "Campbell's Operative Orthopaedics, 15th Edition (2026). Elsevier.",
    "Rockwood and Green's Fractures in Adults, 10th Edition (2025). Wolters Kluwer.",
    "Barash, Cullen & Stoelting's Clinical Anesthesia, 9th Edition. Lippincott.",
    "Tintinalli's Emergency Medicine: A Comprehensive Study Guide. McGraw-Hill.",
    "S Das: A Manual on Clinical Surgery, 13th Edition.",
    "WHO Benchmarks for Equitable Hip-Fracture Care (2022). WHO Press.",
    "McGuire KJ et al. Delays until surgery after hip fracture increases mortality. CORR, 2004;428:294.",
    "Moran CG et al. Early mortality after hip fracture: is delay before surgery important? JBJS Am, 2005;87:483.",
    "Mariconda M et al. Factors predicting mobility and ADL change after hip fracture: 1-year prospective cohort. J Orthop Trauma, 2016;30:71.",
    "Miller's Review of Orthopaedics, 9th Edition (2024). Elsevier.",
    "FRAX Fracture Risk Assessment Tool: www.shef.ac.uk/frax",
  ],
  "References"
);

// ═══════════════════════════════════════════════════════════════════════════════
//  OUTPUT
// ═══════════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/elderly-fractures-ppt/Fractures_in_Elderly.pptx" })
  .then(() => console.log("SUCCESS: Fractures_in_Elderly.pptx created"))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });

cd /home/daytona/workspace/elderly-fractures-ppt && node build.js 2>&1

ls -lh /home/daytona/workspace/elderly-fractures-ppt/

ls /home/daytona/workspace/elderly-fractures-ppt/ && node /home/daytona/workspac…