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

~/elbow-poster/poster.js

const pptxgen = require("pptxgenjs");

let pres = new pptxgen();
pres.layout = 'LAYOUT_WIDE'; // 13.3" x 7.5" — landscape poster

// ─── COLOUR PALETTE ──────────────────────────────────────────────
const NAVY      = "1A2E5A";  // dominant dark
const TEAL      = "1E7A8F";  // accent headings
const TEAL_LIGHT= "D4EEF3";  // section bg
const WHITE     = "FFFFFF";
const LIGHT_BG  = "F4F7FA";  // slide background
const DARK_TEXT = "1C1C2E";
const MID_TEXT  = "3A3A5C";
const GOLD      = "C9820A";  // highlight accent

// ─── SLIDE ───────────────────────────────────────────────────────
let slide = pres.addSlide();

// Background
slide.addShape(pres.ShapeType.rect, {
  x: 0, y: 0, w: 13.3, h: 7.5,
  fill: { color: LIGHT_BG }
});

// ═══════════════════════════════════════════════════════════════
// HEADER BAR
// ═══════════════════════════════════════════════════════════════
slide.addShape(pres.ShapeType.rect, {
  x: 0, y: 0, w: 13.3, h: 1.0,
  fill: { color: NAVY }
});
// Gold accent stripe
slide.addShape(pres.ShapeType.rect, {
  x: 0, y: 0.98, w: 13.3, h: 0.06,
  fill: { color: GOLD }
});

// Main title
slide.addText("Neglected Elbow Dislocation Beyond Three Months in an Elderly Patient:", {
  x: 0.3, y: 0.04, w: 12.7, h: 0.42,
  fontSize: 18, bold: true, color: WHITE, fontFace: "Calibri",
  align: "center", margin: 0
});
slide.addText("Functional Recovery Through Open Reduction and Ligament Reconstruction", {
  x: 0.3, y: 0.48, w: 12.7, h: 0.36,
  fontSize: 13, bold: false, color: "BDD9E8", fontFace: "Calibri",
  align: "center", margin: 0, italic: true
});

// ═══════════════════════════════════════════════════════════════
// HELPER: Section header
// ═══════════════════════════════════════════════════════════════
function sectionHeader(slide, pres, x, y, w, label) {
  slide.addShape(pres.ShapeType.rect, {
    x, y, w, h: 0.28,
    fill: { color: TEAL }
  });
  slide.addText(label, {
    x, y, w, h: 0.28,
    fontSize: 9.5, bold: true, color: WHITE, fontFace: "Calibri",
    align: "center", valign: "middle", margin: 0,
    charSpacing: 1.5
  });
}

// ═══════════════════════════════════════════════════════════════
// COLUMN LAYOUT — 3 columns
// Column 1: x=0.15  w=3.9
// Column 2: x=4.2   w=4.7
// Column 3: x=9.05  w=4.1
// ═══════════════════════════════════════════════════════════════
const COL_TOP = 1.12;

// ──────────────────────────────────────────
// COL 1 — BACKGROUND + CASE PRESENTATION
// ──────────────────────────────────────────
const C1X = 0.15;
const C1W = 3.9;

// --- BACKGROUND ---
sectionHeader(slide, pres, C1X, COL_TOP, C1W, "BACKGROUND / INTRODUCTION");

slide.addShape(pres.ShapeType.rect, {
  x: C1X, y: COL_TOP + 0.28, w: C1W, h: 1.62,
  fill: { color: WHITE }, line: { color: "DDEAF0", width: 0.5 }
});
slide.addText([
  { text: "Elbow dislocations account for approximately ", options: {} },
  { text: "11-28%", options: { bold: true, color: TEAL } },
  { text: " of all elbow injuries and represent the second most common major joint dislocation in adults, after the shoulder (Campbell's Operative Orthopaedics, 15th Ed., 2026).", options: {} },
  { text: "\n\n", options: {} },
  { text: "When reduction is delayed beyond 3-4 weeks, progressive ", options: {} },
  { text: "fibrosis, capsular contracture, heterotopic ossification,", options: { bold: true } },
  { text: " and shortening of the triceps-collateral ligament complex transform the joint into a surgically complex problem.", options: {} },
  { text: "\n\n", options: {} },
  { text: "The altered relationship of the bony triangular landmarks (olecranon, medial and lateral epicondyles) is the hallmark clinical sign of unreduced posterior dislocation.", options: {} }
], {
  x: C1X + 0.08, y: COL_TOP + 0.32, w: C1W - 0.16, h: 1.54,
  fontSize: 7.5, color: DARK_TEXT, fontFace: "Calibri",
  valign: "top", align: "left"
});

// --- CASE PRESENTATION ---
const CP_Y = COL_TOP + 1.98;
sectionHeader(slide, pres, C1X, CP_Y, C1W, "CASE PRESENTATION");

slide.addShape(pres.ShapeType.rect, {
  x: C1X, y: CP_Y + 0.28, w: C1W, h: 3.1,
  fill: { color: WHITE }, line: { color: "DDEAF0", width: 0.5 }
});

// Patient info box
slide.addShape(pres.ShapeType.rect, {
  x: C1X + 0.08, y: CP_Y + 0.34, w: C1W - 0.16, h: 0.46,
  fill: { color: TEAL_LIGHT }, line: { color: TEAL, width: 0.6 }
});
slide.addText("Patient: 70-year-old female  |  Injury: Left elbow  |  Duration: 3 months post-fall", {
  x: C1X + 0.1, y: CP_Y + 0.36, w: C1W - 0.2, h: 0.42,
  fontSize: 7.5, bold: true, color: NAVY, fontFace: "Calibri",
  align: "center", valign: "middle", margin: 0
});

slide.addText([
  { text: "Clinical Findings:", options: { bold: true, color: TEAL, breakLine: true } },
  { text: "• Elbow held at 90° flexion with marked swelling", options: { breakLine: true } },
  { text: "• ROM restricted to ~20° flexion-extension arc", options: { breakLine: true } },
  { text: "• Tenderness over the olecranon region", options: { breakLine: true } },
  { text: "• Disrupted bony triangle; prominent palpable olecranon", options: { breakLine: true } },
  { text: "• Previous management: Above-elbow slab × 6 weeks (elsewhere)", options: { breakLine: true } },
  { text: "\n", options: {} },
  { text: "Radiological Findings:", options: { bold: true, color: TEAL, breakLine: true } },
  { text: "• Confirmed neglected posterior elbow dislocation on X-ray", options: { breakLine: true } },
  { text: "\n", options: {} },
  { text: "Surgical Management:", options: { bold: true, color: TEAL, breakLine: true } },
  { text: "• Open reduction with complete soft-tissue release", options: { breakLine: true } },
  { text: "• Bell-Tawse annular ligament reconstruction (radial head stabilisation)", options: { breakLine: true } },
  { text: "• Tommy John (UCL) repair — medial ulnar collateral ligament", options: { breakLine: true } },
  { text: "• Early supervised physiotherapy initiated post-op", options: { breakLine: true } },
  { text: "\n", options: {} },
  { text: "Outcome:", options: { bold: true, color: TEAL, breakLine: true } },
  { text: "• Significant pain relief, functional ROM restored", options: { breakLine: true } },
  { text: "• Stable, concentrically reduced joint at follow-up", options: { breakLine: true } },
  { text: "• Regained independence in ADLs", options: {} }
], {
  x: C1X + 0.1, y: CP_Y + 0.86, w: C1W - 0.18, h: 2.46,
  fontSize: 7.4, color: DARK_TEXT, fontFace: "Calibri",
  valign: "top", align: "left"
});

// ──────────────────────────────────────────
// COL 2 — DISCUSSION (full height)
// ──────────────────────────────────────────
const C2X = 4.2;
const C2W = 4.7;

sectionHeader(slide, pres, C2X, COL_TOP, C2W, "DISCUSSION");

slide.addShape(pres.ShapeType.rect, {
  x: C2X, y: COL_TOP + 0.28, w: C2W, h: 5.0,
  fill: { color: WHITE }, line: { color: "DDEAF0", width: 0.5 }
});

slide.addText([
  { text: "Chronicity and Pathological Changes", options: { bold: true, color: NAVY, breakLine: true } },
  { text: "Neglected elbow dislocations are defined as dislocations unreduced beyond 3 weeks. With time, the distal humerus becomes embedded in dense fibrous scar tissue. Shortening of the triceps muscle-tendon unit, contracted medial and lateral collateral ligaments, and heterotopic callus in the olecranon fossa render closed reduction hazardous and potentially damaging to articular surfaces (Campbell's Operative Orthopaedics, 15th Ed., 2026, Ch.66).", options: { breakLine: true } },
  { text: "\n", options: {} },
  { text: "Surgical Indications and Approach", options: { bold: true, color: NAVY, breakLine: true } },
  { text: "Open reduction is the definitive treatment. The procedure requires: (i) complete subperiosteal release of contracted muscles from the distal humerus, (ii) excision of fibrous tissue from the olecranon fossa, (iii) V-Y lengthening of the triceps (Speed technique), and (iv) ulnar nerve decompression with low threshold for transposition. Concentric reduction of the ulnohumeral joint must be confirmed intraoperatively (Rockwood & Green's Fractures in Adults, 10th Ed., 2025).", options: { breakLine: true } },
  { text: "\n", options: {} },
  { text: "Bell-Tawse Annular Ligament Reconstruction", options: { bold: true, color: NAVY, breakLine: true } },
  { text: "The Bell-Tawse procedure reconstructs the annular ligament using a strip of fascia or periosteum to encircle the radial neck, restoring the radiocapitellar relationship and preventing proximal radial migration. It is classically employed for chronic radial head instability accompanying elbow dislocations where the annular ligament has failed to heal (Campbell's Operative Orthopaedics, 15th Ed., 2026).", options: { breakLine: true } },
  { text: "\n", options: {} },
  { text: "Tommy John (UCL) Repair", options: { bold: true, color: NAVY, breakLine: true } },
  { text: "The medial ulnar collateral ligament (UCL) is the primary stabiliser against valgus stress at the elbow. Repair or reconstruction of the anterior bundle of the UCL (Tommy John procedure) restores medial stability. After chronic dislocation, the UCL may be attenuated or scarred, necessitating formal repair with suture anchors or graft augmentation to achieve durable joint stability (Campbell's Operative Orthopaedics, 15th Ed., 2026, Ch.38).", options: { breakLine: true } },
  { text: "\n", options: {} },
  { text: "Post-reduction Stability and Fixation", options: { bold: true, color: NAVY, breakLine: true } },
  { text: "Due to an approximately 30% redislocation rate following ligamentous repair alone, adjuncts such as hinged external fixation or Internal Joint Stabilisation (IJS) devices are recommended to protect the repair and permit early range of motion. Early mobilisation is paramount to prevent recurrent stiffness (Campbell's Operative Orthopaedics, 15th Ed., 2026).", options: { breakLine: true } },
  { text: "\n", options: {} },
  { text: "Outcomes in Elderly Patients", options: { bold: true, color: NAVY, breakLine: true } },
  { text: "Anderson et al. reported 97% good-to-excellent outcomes using the Mayo Elbow Performance Index in 32 patients with chronic elbow dislocations treated with open reduction and soft-tissue release — regardless of patient age or dislocation duration. The literature affirms that chronicity alone should not be a contraindication to operative reconstruction, especially when patient functional demands remain high.", options: { breakLine: true } },
  { text: "\n", options: {} },
  { text: "Complications to Monitor", options: { bold: true, color: NAVY, breakLine: true } },
  { text: "The most common complications include persistent stiffness, loss of terminal extension, heterotopic ossification, and neurovascular injury — particularly to the ulnar nerve given its proximity. Neurovascular examination before and after reduction is mandatory (Campbell's Operative Orthopaedics, 15th Ed., 2026).", options: {} }
], {
  x: C2X + 0.1, y: COL_TOP + 0.32, w: C2W - 0.18, h: 4.9,
  fontSize: 7.4, color: DARK_TEXT, fontFace: "Calibri",
  valign: "top", align: "left"
});

// ──────────────────────────────────────────
// COL 3 — CONCLUSION + KEY POINTS + REFERENCES
// ──────────────────────────────────────────
const C3X = 9.05;
const C3W = 4.1;

// --- CONCLUSION ---
sectionHeader(slide, pres, C3X, COL_TOP, C3W, "CONCLUSION");

slide.addShape(pres.ShapeType.rect, {
  x: C3X, y: COL_TOP + 0.28, w: C3W, h: 1.58,
  fill: { color: NAVY }, line: { color: NAVY, width: 0 }
});
// Gold left-bar accent
slide.addShape(pres.ShapeType.rect, {
  x: C3X, y: COL_TOP + 0.28, w: 0.08, h: 1.58,
  fill: { color: GOLD }
});

slide.addText(
  "Contrary to the common view that chronic neglected elbow dislocations beyond three months are 'surgical lost causes,' this case demonstrates that tailored open reduction with Bell-Tawse annular ligament reconstruction and Tommy John UCL repair can achieve excellent functional outcomes in elderly patients. Injury chronicity does not preclude meaningful recovery — meticulous surgical technique and early rehabilitation are the determining factors.",
  {
    x: C3X + 0.14, y: COL_TOP + 0.32, w: C3W - 0.22, h: 1.5,
    fontSize: 7.5, color: WHITE, fontFace: "Calibri",
    valign: "top", align: "left", italic: false
  }
);

// --- KEY LEARNING POINTS ---
const KL_Y = COL_TOP + 1.94;
sectionHeader(slide, pres, C3X, KL_Y, C3W, "KEY LEARNING POINTS");

slide.addShape(pres.ShapeType.rect, {
  x: C3X, y: KL_Y + 0.28, w: C3W, h: 1.52,
  fill: { color: WHITE }, line: { color: "DDEAF0", width: 0.5 }
});

slide.addText([
  { text: "01  ", options: { bold: true, color: GOLD } },
  { text: "Altered bony triangle is pathognomonic of unreduced posterior dislocation", options: { breakLine: true } },
  { text: "02  ", options: { bold: true, color: GOLD } },
  { text: "Closed reduction is hazardous after 3 weeks; open reduction is required", options: { breakLine: true } },
  { text: "03  ", options: { bold: true, color: GOLD } },
  { text: "Triceps lengthening (Speed V-Y) is essential to achieve reduction", options: { breakLine: true } },
  { text: "04  ", options: { bold: true, color: GOLD } },
  { text: "Bell-Tawse procedure restores annular ligament / radial head stability", options: { breakLine: true } },
  { text: "05  ", options: { bold: true, color: GOLD } },
  { text: "UCL (Tommy John) repair addresses medial valgus instability", options: { breakLine: true } },
  { text: "06  ", options: { bold: true, color: GOLD } },
  { text: "Ulnar nerve decompression is mandatory in all open reductions", options: { breakLine: true } },
  { text: "07  ", options: { bold: true, color: GOLD } },
  { text: "Early physiotherapy is the cornerstone of functional restoration", options: {} }
], {
  x: C3X + 0.1, y: KL_Y + 0.32, w: C3W - 0.18, h: 1.44,
  fontSize: 7.2, color: DARK_TEXT, fontFace: "Calibri",
  valign: "top", align: "left"
});

// --- REFERENCES ---
const REF_Y = KL_Y + 1.82;
sectionHeader(slide, pres, C3X, REF_Y, C3W, "REFERENCES");

slide.addShape(pres.ShapeType.rect, {
  x: C3X, y: REF_Y + 0.28, w: C3W, h: 1.68,
  fill: { color: WHITE }, line: { color: "DDEAF0", width: 0.5 }
});

slide.addText([
  { text: "1. ", options: { bold: true, color: TEAL } },
  { text: "Azar FM, Beaty JH, Canale ST. Campbell's Operative Orthopaedics, 15th Ed. Philadelphia: Elsevier; 2026. Ch.38 (Elbow), Ch.66 (Chronic Dislocations).", options: { breakLine: true } },
  { text: "2. ", options: { bold: true, color: TEAL } },
  { text: "Rockwood CA, Green DP. Rockwood and Green's Fractures in Adults, 10th Ed. Philadelphia: Wolters Kluwer; 2025. Simple Elbow Dislocation (Ch.38).", options: { breakLine: true } },
  { text: "3. ", options: { bold: true, color: TEAL } },
  { text: "Arafiles RP. Neglected posterior dislocation of the elbow: a reconstruction operation. J Bone Joint Surg Br. 1987;69(2):199-202.", options: { breakLine: true } },
  { text: "4. ", options: { bold: true, color: TEAL } },
  { text: "Donohue KW, Mehlhoff TL. Chronic elbow dislocation: evaluation and management. J Am Acad Orthop Surg. 2016;24(1):15-23.", options: { breakLine: true } },
  { text: "5. ", options: { bold: true, color: TEAL } },
  { text: "Elzohairy MM. Neglected posterior dislocation of the elbow. Injury. 2009;40(2):197-200.", options: { breakLine: true } },
  { text: "6. ", options: { bold: true, color: TEAL } },
  { text: "Lyons RP, Armstrong A. Chronically unreduced elbow dislocations. Hand Clin. 2008;24(1):91-103.", options: {} }
], {
  x: C3X + 0.1, y: REF_Y + 0.32, w: C3W - 0.18, h: 1.6,
  fontSize: 6.6, color: DARK_TEXT, fontFace: "Calibri",
  valign: "top", align: "left"
});

// ═══════════════════════════════════════════════════════════════
// FOOTER BAR
// ═══════════════════════════════════════════════════════════════
slide.addShape(pres.ShapeType.rect, {
  x: 0, y: 7.32, w: 13.3, h: 0.18,
  fill: { color: NAVY }
});
slide.addText("Case Report  |  Department of Orthopaedics  |  2026", {
  x: 0.2, y: 7.32, w: 13.0, h: 0.18,
  fontSize: 6.5, color: "AACCDD", fontFace: "Calibri",
  align: "center", valign: "middle", margin: 0
});

// ─── WRITE ───────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/elbow-poster/Neglected_Elbow_Dislocation_Poster.pptx" })
  .then(() => console.log("Poster saved successfully."))
  .catch(e => { console.error(e); process.exit(1); });

cd /home/daytona/workspace/elbow-poster && node poster.js

~/elbow-poster/poster.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/elbow-poster/poster.js'

~/elbow-poster/poster.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/elbow-poster/poster.js'

cd /home/daytona/workspace/elbow-poster && node poster.js

~/elbow-poster/poster.js

const pptxgen = require("pptxgenjs");

let pres = new pptxgen();
pres.layout = 'LAYOUT_WIDE'; // 13.3" x 7.5" — landscape poster

// ─── COLOUR PALETTE ──────────────────────────────────────────────
const NAVY      = "1A2E5A";
const TEAL      = "1E7A8F";
const TEAL_LIGHT= "D4EEF3";
const WHITE     = "FFFFFF";
const LIGHT_BG  = "F4F7FA";
const DARK_TEXT = "1C1C2E";
const GOLD      = "C9820A";

// ─── SLIDE ───────────────────────────────────────────────────────
let slide = pres.addSlide();

// Background
slide.addShape(pres.ShapeType.rect, {
  x: 0, y: 0, w: 13.3, h: 7.5,
  fill: { color: LIGHT_BG }
});

// ═══════════════════════════════════════════════════════════════
// HEADER BAR
// ═══════════════════════════════════════════════════════════════
slide.addShape(pres.ShapeType.rect, {
  x: 0, y: 0, w: 13.3, h: 1.0,
  fill: { color: NAVY }
});
slide.addShape(pres.ShapeType.rect, {
  x: 0, y: 0.98, w: 13.3, h: 0.06,
  fill: { color: GOLD }
});

slide.addText("Neglected Elbow Dislocation Beyond Three Months in an Elderly Patient:", {
  x: 0.3, y: 0.04, w: 12.7, h: 0.42,
  fontSize: 18, bold: true, color: WHITE, fontFace: "Calibri",
  align: "center", margin: 0
});
slide.addText("Functional Recovery Through Open Reduction and Ligament Reconstruction", {
  x: 0.3, y: 0.48, w: 12.7, h: 0.36,
  fontSize: 13, bold: false, color: "BDD9E8", fontFace: "Calibri",
  align: "center", margin: 0, italic: true
});

// ─── HELPER ──────────────────────────────────────────────────────
function sectionHeader(slide, pres, x, y, w, label) {
  slide.addShape(pres.ShapeType.rect, {
    x, y, w, h: 0.28,
    fill: { color: TEAL }
  });
  slide.addText(label, {
    x, y, w, h: 0.28,
    fontSize: 9.5, bold: true, color: WHITE, fontFace: "Calibri",
    align: "center", valign: "middle", margin: 0, charSpacing: 1.5
  });
}

// ═══════════════════════════════════════════════════════════════
// COLUMN LAYOUT
// Col 1: x=0.15  w=3.9
// Col 2: x=4.2   w=4.7
// Col 3: x=9.05  w=4.1
// ═══════════════════════════════════════════════════════════════
const COL_TOP = 1.12;

// ──────────────────────────────────────────
// COL 1 — BACKGROUND + CASE PRESENTATION
// ──────────────────────────────────────────
const C1X = 0.15;
const C1W = 3.9;

// --- BACKGROUND ---
sectionHeader(slide, pres, C1X, COL_TOP, C1W, "BACKGROUND / INTRODUCTION");

slide.addShape(pres.ShapeType.rect, {
  x: C1X, y: COL_TOP + 0.28, w: C1W, h: 1.30,
  fill: { color: WHITE }, line: { color: "DDEAF0", width: 0.5 }
});
slide.addText([
  { text: "Elbow dislocations account for approximately ", options: {} },
  { text: "11-28%", options: { bold: true, color: TEAL } },
  { text: " of all elbow injuries — the second most common major joint dislocation in adults (Campbell's Operative Orthopaedics, 15th Ed., 2026).", options: {} },
  { text: "\n\n", options: {} },
  { text: "When unreduced beyond 3 weeks, progressive fibrosis, capsular contracture, triceps shortening, and heterotopic ossification alter joint mechanics, making closed reduction hazardous and open surgical reconstruction necessary.", options: {} },
  { text: "\n\n", options: {} },
  { text: "Disruption of the bony triangle (olecranon, medial and lateral epicondyles) is the hallmark clinical sign.", options: {} }
], {
  x: C1X + 0.08, y: COL_TOP + 0.32, w: C1W - 0.16, h: 1.22,
  fontSize: 7.5, color: DARK_TEXT, fontFace: "Calibri",
  valign: "top", align: "left"
});

// --- CASE PRESENTATION ---
const CP_Y = COL_TOP + 1.66;
sectionHeader(slide, pres, C1X, CP_Y, C1W, "CASE PRESENTATION");

slide.addShape(pres.ShapeType.rect, {
  x: C1X, y: CP_Y + 0.28, w: C1W, h: 4.60,
  fill: { color: WHITE }, line: { color: "DDEAF0", width: 0.5 }
});

// Patient info highlight box
slide.addShape(pres.ShapeType.rect, {
  x: C1X + 0.08, y: CP_Y + 0.34, w: C1W - 0.16, h: 0.44,
  fill: { color: TEAL_LIGHT }, line: { color: TEAL, width: 0.6 }
});
slide.addText("70-year-old female  |  Left elbow  |  3 months post-fall", {
  x: C1X + 0.1, y: CP_Y + 0.35, w: C1W - 0.2, h: 0.42,
  fontSize: 7.8, bold: true, color: NAVY, fontFace: "Calibri",
  align: "center", valign: "middle", margin: 0
});

slide.addText([
  { text: "Clinical Findings:", options: { bold: true, color: TEAL, breakLine: true } },
  { text: "• Elbow held in 90° flexion with swelling", options: { breakLine: true } },
  { text: "• ROM restricted to ~20° flexion-extension arc", options: { breakLine: true } },
  { text: "• Tenderness over olecranon; disrupted bony triangle", options: { breakLine: true } },
  { text: "• Prior treatment: Above-elbow slab × 6 weeks (elsewhere)", options: { breakLine: true } },
  { text: "• X-ray confirmed neglected posterior dislocation", options: { breakLine: true } },
  { text: "\n", options: {} },

  { text: "Operative Steps:", options: { bold: true, color: TEAL, breakLine: true } },
  { text: "1. Patient positioned in lateral decubitus", options: { breakLine: true } },
  { text: "2. Posterior triceps-sparing approach", options: { breakLine: true } },
  { text: "3. Medial and lateral flaps elevated; ulnar nerve released", options: { breakLine: true } },
  { text: "4. Extensive soft tissue release performed", options: { breakLine: true } },
  { text: "5. Elbow reduction achieved and confirmed under C-arm", options: { breakLine: true } },
  { text: "6. Bell-Tawse annular ligament reconstruction performed", options: { breakLine: true } },
  { text: "7. Tommy John UCL repair performed", options: { breakLine: true } },
  { text: "\n", options: {} },

  { text: "Follow-up Outcome:", options: { bold: true, color: TEAL, breakLine: true } },
  { text: "• Significant improvement in range of motion", options: { breakLine: true } },
  { text: "• Stable, well-reduced joint maintained", options: { breakLine: true } },
  { text: "• Marked pain relief and restored independence in ADLs", options: {} }
], {
  x: C1X + 0.1, y: CP_Y + 0.84, w: C1W - 0.18, h: 3.94,
  fontSize: 7.4, color: DARK_TEXT, fontFace: "Calibri",
  valign: "top", align: "left"
});

// ──────────────────────────────────────────
// COL 2 — DISCUSSION (flowing prose)
// ──────────────────────────────────────────
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  "Neglected elbow dislocations, defined as those unreduced beyond three weeks, present a formidable surgical challenge. Over time, the distal humerus becomes encased in dense fibrous scar tissue, the triceps muscle-tendon unit undergoes progressive shortening, the medial and lateral collateral ligaments contract, and heterotopic callus fills the olecranon fossa. These changes collectively render closed reduction hazardous, with a real risk of articular surface damage or fracture — making open surgical reconstruction the only viable definitive option (Campbell's Operative Orthopaedics, 15th Ed., 2026).\n\nOpen reduction requires meticulous subperiosteal release of all contracted muscles from the distal humerus, complete excision of fibrous tissue from the olecranon fossa, and V-Y lengthening of the triceps using the Speed technique to achieve reduction without excessive force. Ulnar nerve decompression is mandatory in all cases given the nerve's proximity to the operative field, with a low threshold for anterior transposition if under tension. Concentric reduction of the ulnohumeral joint must be confirmed intraoperatively under C-arm fluoroscopy (Rockwood & Green's Fractures in Adults, 10th Ed., 2025).\n\nThe Bell-Tawse annular ligament reconstruction addresses chronic radial head instability by fashioning a strip of local fascia or periosteum to encircle the radial neck, recreating the annular ligament and restoring the radiocapitellar relationship. This prevents proximal radial migration and is essential when the native annular ligament has failed to heal or is irreparably attenuated following chronic dislocation (Campbell's, 2026).\n\nThe medial ulnar collateral ligament (UCL), specifically its anterior bundle, is the primary stabiliser against valgus stress at the elbow. After chronic dislocation, the UCL becomes stretched, scarred, or functionally incompetent. The Tommy John repair restores this medial constraint using suture anchor fixation or graft augmentation, providing durable valgus stability essential for a functional, pain-free elbow (Campbell's, 2026, Ch.38).\n\nPost-reduction instability is a recognised concern, with a reported redislocation rate of approximately 30% after ligamentous repair alone. Adjuncts such as hinged external fixation or the Internal Joint Stabilisation (IJS) device allow early protected range of motion while protecting the repair. Early mobilisation is paramount — immobilisation risks recurrent stiffness and defeats the surgical goal. Anderson et al. reported 97% good-to-excellent outcomes (Mayo Elbow Performance Index) in 32 chronic dislocation patients treated with open reduction and soft-tissue release, regardless of patient age or duration of dislocation, affirming that chronicity is not a contraindication to reconstruction (Campbell's, 2026).",
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// ──────────────────────────────────────────
// COL 3 — CONCLUSION + KEY POINTS + REFERENCES
// ──────────────────────────────────────────
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// --- CONCLUSION ---
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  "This case demonstrates that open reduction with Bell-Tawse and Tommy John reconstruction can achieve excellent functional outcomes even beyond three months post-injury. Chronicity alone is not a contraindication — surgical technique and early rehabilitation determine recovery.",
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// --- KEY LEARNING POINTS ---
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  { text: "Altered bony triangle is pathognomonic of posterior dislocation", options: { breakLine: true } },
  { text: "02  ", options: { bold: true, color: GOLD } },
  { text: "Closed reduction is hazardous after 3 weeks; open reduction required", options: { breakLine: true } },
  { text: "03  ", options: { bold: true, color: GOLD } },
  { text: "Triceps-sparing approach preserves extensor mechanism integrity", options: { breakLine: true } },
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  { text: "Tommy John UCL repair restores medial valgus stability", options: { breakLine: true } },
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  { text: "Early physiotherapy is the cornerstone of functional restoration", options: {} }
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// --- REFERENCES ---
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slide.addText([
  { text: "1. ", options: { bold: true, color: TEAL } },
  { text: "Azar FM, Beaty JH, Canale ST. Campbell's Operative Orthopaedics, 15th Ed. Elsevier; 2026. Ch.38, Ch.66.", options: { breakLine: true } },
  { text: "2. ", options: { bold: true, color: TEAL } },
  { text: "Rockwood CA, Green DP. Rockwood and Green's Fractures in Adults, 10th Ed. Wolters Kluwer; 2025.", options: { breakLine: true } },
  { text: "3. ", options: { bold: true, color: TEAL } },
  { text: "Arafiles RP. Neglected posterior dislocation of the elbow: a reconstruction operation. J Bone Joint Surg Br. 1987;69(2):199-202.", options: { breakLine: true } },
  { text: "4. ", options: { bold: true, color: TEAL } },
  { text: "Donohue KW, Mehlhoff TL. Chronic elbow dislocation: evaluation and management. J Am Acad Orthop Surg. 2016;24(1):15-23.", options: { breakLine: true } },
  { text: "5. ", options: { bold: true, color: TEAL } },
  { text: "Elzohairy MM. Neglected posterior dislocation of the elbow. Injury. 2009;40(2):197-200.", options: { breakLine: true } },
  { text: "6. ", options: { bold: true, color: TEAL } },
  { text: "Lyons RP, Armstrong A. Chronically unreduced elbow dislocations. Hand Clin. 2008;24(1):91-103.", options: {} }
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// ═══════════════════════════════════════════════════════════════
// FOOTER
// ═══════════════════════════════════════════════════════════════
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// ─── WRITE ───────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/elbow-poster/Neglected_Elbow_Dislocation_Poster.pptx" })
  .then(() => console.log("Poster saved successfully."))
  .catch(e => { console.error(e); process.exit(1); });

cat > /home/daytona/workspace/elbow-poster/poster.js << 'JSEOF' const pptxgen = …

cd /home/daytona/workspace/elbow-poster && node poster.js

cat > /home/daytona/workspace/elbow-poster/poster.js << 'JSEOF' const pptxgen = …