Clinical Anatomy of the Elbow Joint

ls /home/daytona/workspace/ 2>/dev/null || echo "workspace not found"

mkdir -p /home/daytona/workspace/elbow-revision

~/elbow-revision/generate_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import PageBreak

OUTPUT = "/home/daytona/workspace/elbow-revision/Elbow_Joint_Fractures_Revision.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=1.8*cm, leftMargin=1.8*cm,
    topMargin=2*cm, bottomMargin=2*cm
)

W, H = A4

# ── Colour palette ─────────────────────────────────────────────────────────────
NAVY     = colors.HexColor("#1A3560")
BLUE     = colors.HexColor("#2563EB")
LBLUE    = colors.HexColor("#DBEAFE")
ORANGE   = colors.HexColor("#EA580C")
LORANGE  = colors.HexColor("#FFF7ED")
GREEN    = colors.HexColor("#16A34A")
LGREEN   = colors.HexColor("#F0FDF4")
RED      = colors.HexColor("#DC2626")
LRED     = colors.HexColor("#FEF2F2")
YELLOW   = colors.HexColor("#CA8A04")
LYELLOW  = colors.HexColor("#FEFCE8")
PURPLE   = colors.HexColor("#7C3AED")
LPURPLE  = colors.HexColor("#F5F3FF")
GREY     = colors.HexColor("#F1F5F9")
DGREY    = colors.HexColor("#475569")
BLACK    = colors.HexColor("#0F172A")
WHITE    = colors.white

styles = getSampleStyleSheet()

def S(name, **kw):
    return ParagraphStyle(name, **kw)

# ── Custom styles ──────────────────────────────────────────────────────────────
title_style = S("Title",
    fontSize=22, fontName="Helvetica-Bold", textColor=WHITE,
    alignment=TA_CENTER, spaceAfter=4)

subtitle_style = S("Subtitle",
    fontSize=11, fontName="Helvetica", textColor=colors.HexColor("#BFDBFE"),
    alignment=TA_CENTER, spaceAfter=2)

tag_style = S("Tag",
    fontSize=9, fontName="Helvetica-Oblique", textColor=colors.HexColor("#93C5FD"),
    alignment=TA_CENTER)

section_style = S("Section",
    fontSize=13, fontName="Helvetica-Bold", textColor=WHITE,
    alignment=TA_LEFT, spaceAfter=0, spaceBefore=0,
    leftPadding=8)

body_style = S("Body",
    fontSize=9.5, fontName="Helvetica", textColor=BLACK,
    leading=14, spaceAfter=3, alignment=TA_JUSTIFY)

bold_body = S("BoldBody",
    fontSize=9.5, fontName="Helvetica-Bold", textColor=BLACK,
    leading=14, spaceAfter=3)

bullet_style = S("Bullet",
    fontSize=9.2, fontName="Helvetica", textColor=BLACK,
    leading=13.5, leftIndent=12, spaceAfter=2,
    bulletIndent=0, bulletFontName="Helvetica")

warn_style = S("Warn",
    fontSize=9, fontName="Helvetica-Bold", textColor=RED,
    leading=13, leftIndent=8, spaceAfter=2)

note_style = S("Note",
    fontSize=8.8, fontName="Helvetica-Oblique", textColor=DGREY,
    leading=13, alignment=TA_JUSTIFY)

table_header_style = S("TableHeader",
    fontSize=8.5, fontName="Helvetica-Bold", textColor=WHITE,
    alignment=TA_CENTER, leading=11)

table_cell_style = S("TableCell",
    fontSize=8.5, fontName="Helvetica", textColor=BLACK,
    alignment=TA_LEFT, leading=11)

mnemonic_style = S("Mnemonic",
    fontSize=11, fontName="Helvetica-Bold", textColor=PURPLE,
    alignment=TA_CENTER, leading=18)

footer_style = S("Footer",
    fontSize=7.5, fontName="Helvetica-Oblique", textColor=DGREY,
    alignment=TA_CENTER)

# ── Helper builders ────────────────────────────────────────────────────────────

def header_bar(text, bg=NAVY, text_color=WHITE):
    data = [[Paragraph(text, ParagraphStyle("hdr",
                fontSize=12, fontName="Helvetica-Bold",
                textColor=text_color, alignment=TA_LEFT, leading=15))]]
    t = Table(data, colWidths=[doc.width])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("LEFTPADDING",  (0,0), (-1,-1), 10),
        ("RIGHTPADDING", (0,0), (-1,-1), 6),
        ("TOPPADDING",   (0,0), (-1,-1), 6),
        ("BOTTOMPADDING",(0,0), (-1,-1), 6),
        ("ROUNDEDCORNERS", [4]),
    ]))
    return t

def two_col_table(rows, col1_w=4.5*cm, bg_header=NAVY, header_row=None):
    col2_w = doc.width - col1_w
    data = []
    if header_row:
        data.append([
            Paragraph(header_row[0], table_header_style),
            Paragraph(header_row[1], table_header_style)
        ])
    for r in rows:
        data.append([
            Paragraph(r[0], bold_body),
            Paragraph(r[1], body_style)
        ])
    t = Table(data, colWidths=[col1_w, col2_w])
    style = [
        ("GRID",        (0,0), (-1,-1), 0.4, colors.HexColor("#CBD5E1")),
        ("TOPPADDING",  (0,0), (-1,-1), 4),
        ("BOTTOMPADDING",(0,0),(-1,-1), 4),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
        ("RIGHTPADDING",(0,0), (-1,-1), 6),
        ("VALIGN",      (0,0), (-1,-1), "TOP"),
        ("ROWBACKGROUNDS", (0,0), (-1,-1), [GREY, WHITE]),
    ]
    if header_row:
        style += [
            ("BACKGROUND",   (0,0), (-1,0), bg_header),
            ("ROWBACKGROUNDS",(0,1),(-1,-1), [WHITE, GREY]),
        ]
    t.setStyle(TableStyle(style))
    return t

def three_col_table(rows, widths, header_row=None, bg_header=NAVY):
    data = []
    if header_row:
        data.append([Paragraph(h, table_header_style) for h in header_row])
    for r in rows:
        data.append([Paragraph(c, body_style) for c in r])
    t = Table(data, colWidths=widths)
    style = [
        ("GRID",        (0,0), (-1,-1), 0.4, colors.HexColor("#CBD5E1")),
        ("TOPPADDING",  (0,0), (-1,-1), 4),
        ("BOTTOMPADDING",(0,0),(-1,-1), 4),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
        ("RIGHTPADDING",(0,0), (-1,-1), 6),
        ("VALIGN",      (0,0), (-1,-1), "TOP"),
        ("ROWBACKGROUNDS",(0,0),(-1,-1), [GREY, WHITE]),
    ]
    if header_row:
        style += [
            ("BACKGROUND",   (0,0), (-1,0), bg_header),
            ("FONTNAME",     (0,0), (-1,0), "Helvetica-Bold"),
            ("TEXTCOLOR",    (0,0), (-1,0), WHITE),
            ("ROWBACKGROUNDS",(0,1),(-1,-1), [WHITE, GREY]),
        ]
    t.setStyle(TableStyle(style))
    return t

def colored_box(content_rows, bg=LBLUE, border=BLUE):
    """Wrap a list of flowables in a colored 1-cell table."""
    inner = []
    for item in content_rows:
        inner.append(item)
    data = [[inner]]
    t = Table([[content_rows]], colWidths=[doc.width])
    # Use a simpler approach - just a paragraph list in a table cell
    cell_content = "".join(
        f"<para>{r}</para>" for r in content_rows
    ) if isinstance(content_rows[0], str) else None
    return t

def info_box(paragraphs_list, bg=LBLUE, border_color=BLUE):
    data = [[paragraphs_list]]
    t = Table(data, colWidths=[doc.width])
    t.setStyle(TableStyle([
        ("BACKGROUND",   (0,0), (-1,-1), bg),
        ("BOX",          (0,0), (-1,-1), 1.2, border_color),
        ("LEFTPADDING",  (0,0), (-1,-1), 10),
        ("RIGHTPADDING", (0,0), (-1,-1), 10),
        ("TOPPADDING",   (0,0), (-1,-1), 8),
        ("BOTTOMPADDING",(0,0), (-1,-1), 8),
        ("VALIGN",       (0,0), (-1,-1), "TOP"),
    ]))
    return t

def bullet(text, color="•"):
    return Paragraph(f"{color} {text}", bullet_style)

# ══════════════════════════════════════════════════════════════════════════════
# BUILD CONTENT
# ══════════════════════════════════════════════════════════════════════════════
story = []

# ── COVER BANNER ──────────────────────────────────────────────────────────────
cover_data = [[
    Paragraph("ELBOW JOINT FRACTURES", title_style),
    Paragraph("Quick Revision Notes — 1st Year MBBS", subtitle_style),
    Paragraph("Anatomy • Clinical Features • Complications • Management", tag_style),
]]
cover = Table(cover_data, colWidths=[doc.width])
cover.setStyle(TableStyle([
    ("BACKGROUND",   (0,0), (-1,-1), NAVY),
    ("BOX",          (0,0), (-1,-1), 0, NAVY),
    ("TOPPADDING",   (0,0), (-1,-1), 18),
    ("BOTTOMPADDING",(0,0), (-1,-1), 18),
    ("LEFTPADDING",  (0,0), (-1,-1), 14),
    ("RIGHTPADDING", (0,0), (-1,-1), 14),
    ("ROUNDEDCORNERS",[6]),
]))
story.append(cover)
story.append(Spacer(1, 0.35*cm))

# ── QUICK OVERVIEW TABLE ───────────────────────────────────────────────────────
story.append(header_bar("📋  AT A GLANCE — Elbow Fracture Types", NAVY))
story.append(Spacer(1, 0.2*cm))

overview_rows = [
    ["Supracondylar Hx", "Distal humerus above epicondyles", "Children 5–10 yrs", "FOOSH"],
    ["Lateral Condyle Fx", "Lateral condyle of humerus", "Children 5–10 yrs", "FOOSH + varus force"],
    ["Medial Epicondyle Fx", "Medial epicondyle avulsion", "Children/adolescents", "Valgus stress / dislocation"],
    ["Olecranon Fx", "Olecranon process of ulna", "Adults", "Direct blow / triceps avulsion"],
    ["Radial Head Fx", "Head of radius", "Adults", "FOOSH"],
    ["Intercondylar Fx", "T/Y fracture through condyles", "Elderly adults", "High energy trauma"],
    ["Nursemaid's Elbow", "Radial head subluxation", "< 5 years", "Axial pull on hand"],
]
w1 = 3.8*cm; w2 = 4.5*cm; w3 = 3.2*cm; w4 = doc.width - w1 - w2 - w3
overview = three_col_table(
    overview_rows,
    widths=[w1, w2, w3, w4],
    header_row=["Fracture", "Site", "Age Group", "Mechanism"],
    bg_header=NAVY
)
story.append(overview)
story.append(Spacer(1, 0.4*cm))

# ══════════════════════════════════════════════════════════════════════════════
# 1. SUPRACONDYLAR FRACTURE
# ══════════════════════════════════════════════════════════════════════════════
story.append(KeepTogether([
    header_bar("1.  SUPRACONDYLAR FRACTURE OF HUMERUS", BLUE),
    Spacer(1, 0.15*cm),
]))

sc_rows = [
    ["Site", "Transverse fracture of distal humerus ABOVE the level of epicondyles"],
    ["Age / Incidence", "Most common elbow fracture in children (5–10 yrs). Rare in adults."],
    ["Mechanism", "Fall on outstretched hand (FOOSH) — extension type (95%). Flexion type (5%) — direct blow on flexed elbow."],
    ["Displacement", "Posterior displacement of distal fragment by triceps pull (extension type)."],
    ["Classification", "Gartland I — undisplaced  |  II — partially displaced  |  III — fully displaced"],
]
story.append(two_col_table(sc_rows, col1_w=3.5*cm))
story.append(Spacer(1, 0.2*cm))

# Clinical features sub-header
story.append(Paragraph("<b>Clinical Features</b>", bold_body))
sc_cf = [
    bullet("Pain, swelling, tenderness around the elbow"),
    bullet("S-shaped deformity (extension type)"),
    bullet("Posterior prominence of olecranon"),
    bullet("Normal triangle of bony points (medial epicondyle, lateral epicondyle, olecranon) — PRESERVED (unlike dislocation)"),
    bullet("Pucker sign: Puckering of skin anteriorly due to proximal fragment piercing brachialis"),
]
story.append(info_box(sc_cf, bg=LBLUE, border_color=BLUE))
story.append(Spacer(1, 0.2*cm))

# Neurovascular complications
story.append(Paragraph("<b>⚠ Complications — The Most Important Part!</b>", warn_style))
comp_rows = [
    ["Brachial Artery Injury", "Bowstringing over proximal fragment → ischaemia → Volkmann's Ischaemic Contracture (VIC)"],
    ["Anterior Interosseous N. (AIN)", "Branch of median nerve. Test: 'OK sign' — inability to flex terminal IP of thumb + index finger"],
    ["Radial Nerve", "Less common. Wrist drop."],
    ["Median Nerve", "Rare. Sensory loss over lateral 3½ fingers."],
    ["Ulnar Nerve", "Most common in flexion type fractures."],
    ["Cubitus Varus (Gunstock deformity)", "Most common late complication. Due to malunion. Cosmetic, not functional."],
    ["Cubitus Valgus", "Less common. Can cause delayed ulnar nerve palsy."],
    ["Myositis Ossificans", "Heterotopic ossification — avoid passive stretching."],
]
story.append(two_col_table(comp_rows, col1_w=4.2*cm, bg_header=RED,
    header_row=["Complication", "Details"]))
story.append(Spacer(1, 0.2*cm))

story.append(Paragraph("<b>Volkmann's Ischaemic Contracture (VIC)</b>", bold_body))
vic_items = [
    bullet("Caused by ischaemia of anterior compartment muscles (flexors of forearm)"),
    bullet("Classic triad: Pain on passive extension of fingers + Pallor + Pulselessness"),
    bullet("Late: Wrist flexion + finger flexion contracture (clawing), forearm pronation"),
    bullet("3 Ps of compartment syndrome: Pain, Pallor, Pulselessness (also Paraesthesia, Paralysis)"),
]
story.append(info_box(vic_items, bg=LRED, border_color=RED))
story.append(Spacer(1, 0.2*cm))

story.append(Paragraph("<b>Management</b>", bold_body))
mgmt_rows = [
    ["Gartland I", "Above-elbow POP cast in 90° flexion for 3 weeks"],
    ["Gartland II", "Closed reduction + POP / percutaneous K-wire fixation"],
    ["Gartland III", "Closed reduction + percutaneous K-wire (crossed or lateral). ORIF if closed fails."],
    ["Neurovascular compromise", "Urgent reduction. If no pulse after reduction → explore brachial artery."],
]
story.append(two_col_table(mgmt_rows, col1_w=3.5*cm))
story.append(Spacer(1, 0.5*cm))

# ══════════════════════════════════════════════════════════════════════════════
# 2. LATERAL CONDYLE FRACTURE
# ══════════════════════════════════════════════════════════════════════════════
story.append(KeepTogether([
    header_bar("2.  LATERAL CONDYLE FRACTURE", colors.HexColor("#0369A1")),
    Spacer(1, 0.15*cm),
]))

lc_rows = [
    ["Site", "Fracture through lateral condyle of humerus (Salter-Harris Type IV physeal injury)"],
    ["Age", "2nd most common elbow fracture in children (5–10 yrs)"],
    ["Mechanism", "FOOSH with varus stress / avulsion by common extensor origin"],
    ["Key Feature", "Fracture line enters the joint — intra-articular. Risk of non-union is HIGH."],
    ["Classification", "Milch Type I (lateral trochlear ridge intact) & Type II (fracture through trochlear groove)"],
]
story.append(two_col_table(lc_rows, col1_w=3.5*cm))

lc_comp = [
    bullet("Non-union (most common complication) → fishtail deformity on X-ray"),
    bullet("Malunion → Cubitus valgus → Late ulnar nerve palsy (tardy ulnar palsy)"),
    bullet("Avascular necrosis of lateral condyle"),
    bullet("Stiffness"),
]
story.append(Spacer(1, 0.15*cm))
story.append(Paragraph("<b>Complications</b>", bold_body))
story.append(info_box(lc_comp, bg=LYELLOW, border_color=YELLOW))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph("<b>Management</b>: Undisplaced → POP cast. Displaced → ORIF with K-wires or screws.", body_style))
story.append(Spacer(1, 0.4*cm))

# ══════════════════════════════════════════════════════════════════════════════
# 3. MEDIAL EPICONDYLE FRACTURE
# ══════════════════════════════════════════════════════════════════════════════
story.append(KeepTogether([
    header_bar("3.  MEDIAL EPICONDYLE FRACTURE", colors.HexColor("#0F766E")),
    Spacer(1, 0.15*cm),
]))

me_rows = [
    ["Type", "Extra-articular avulsion fracture (apophyseal)"],
    ["Age", "Adolescents (10–15 yrs). Ossification centre appears at ~5 yrs."],
    ["Mechanism", "Valgus stress (FOOSH) or elbow dislocation (associated in 50% cases)"],
    ["Key Point", "Epicondyle may become trapped inside the joint following reduction of dislocation — check post-reduction X-ray!"],
]
story.append(two_col_table(me_rows, col1_w=3.5*cm))
story.append(Spacer(1, 0.15*cm))
story.append(Paragraph(
    "<b>Nerve at Risk:</b> Ulnar nerve (runs in groove posterior to medial epicondyle). "
    "Injury causes: Weakness of intrinsic hand muscles, claw hand, sensory loss over medial 1½ fingers.",
    body_style))
story.append(Spacer(1, 0.15*cm))
story.append(Paragraph("<b>Management</b>: Undisplaced → conservative. Displaced / incarcerated in joint → ORIF.", body_style))
story.append(Spacer(1, 0.4*cm))

# ══════════════════════════════════════════════════════════════════════════════
# 4. OLECRANON FRACTURE
# ══════════════════════════════════════════════════════════════════════════════
story.append(KeepTogether([
    header_bar("4.  OLECRANON FRACTURE", ORANGE),
    Spacer(1, 0.15*cm),
]))

ol_rows = [
    ["Site", "Olecranon process of ulna (insertion of triceps brachii)"],
    ["Age", "Adults (all ages)"],
    ["Mechanism", "1. Direct blow to olecranon  2. FOOSH + triceps avulsion  3. Avulsion by triceps contraction"],
    ["Clinical", "Pain, swelling over olecranon. Gap palpable at fracture site. INABILITY TO EXTEND the elbow actively."],
    ["X-ray", "Lateral view — transverse fracture at olecranon. Check for displacement."],
]
story.append(two_col_table(ol_rows, col1_w=3.5*cm))
story.append(Spacer(1, 0.15*cm))
ol_mgmt = [
    bullet("Undisplaced: Above elbow POP in 90° flexion for 3–4 weeks"),
    bullet("Displaced: Tension band wiring (TBW) — converts tensile force to compressive force at fracture site"),
    bullet("Comminuted: Plate and screw fixation or olecranon excision (elderly)"),
]
story.append(Paragraph("<b>Management</b>", bold_body))
story.append(info_box(ol_mgmt, bg=LORANGE, border_color=ORANGE))
story.append(Spacer(1, 0.4*cm))

# ══════════════════════════════════════════════════════════════════════════════
# 5. RADIAL HEAD FRACTURE
# ══════════════════════════════════════════════════════════════════════════════
story.append(KeepTogether([
    header_bar("5.  FRACTURE OF HEAD OF RADIUS", GREEN),
    Spacer(1, 0.15*cm),
]))

rh_rows = [
    ["Mechanism", "FOOSH — axial force transmitted up radius to radial head"],
    ["Age", "Adults (20–60 yrs). Most common elbow fracture in adults."],
    ["Clinical", "Lateral elbow pain, tenderness over radial head, painful pronation/supination, restricted extension"],
    ["X-ray Sign", "Posterior fat pad sign (sail sign) on lateral view = haemarthrosis = intra-articular fracture"],
    ["Classification", "Mason Classification (I–III, +/- Essex-Lopresti variant)"],
]
story.append(two_col_table(rh_rows, col1_w=3.5*cm))
story.append(Spacer(1, 0.15*cm))

mason_rows = [
    ["Mason I", "Undisplaced marginal fracture", "Sling, early mobilization"],
    ["Mason II", "Displaced / angulated (>30°, >30% head)", "ORIF with Herbert screw"],
    ["Mason III", "Comminuted fracture of entire head", "Radial head excision or prosthetic replacement"],
    ["Mason IV", "Any of above + elbow dislocation", "Treat dislocation first, then fracture"],
]
story.append(three_col_table(
    mason_rows,
    widths=[2.5*cm, 8.0*cm, doc.width-2.5*cm-8.0*cm],
    header_row=["Type", "Description", "Treatment"],
    bg_header=GREEN
))
story.append(Spacer(1, 0.15*cm))
story.append(Paragraph(
    "<b>Essex-Lopresti injury:</b> Radial head fracture + disruption of interosseous membrane + "
    "distal radioulnar joint subluxation. Do NOT excise radial head — causes proximal migration of radius.",
    body_style))
story.append(Spacer(1, 0.4*cm))

# ══════════════════════════════════════════════════════════════════════════════
# 6. PULLED ELBOW (NURSEMAID'S ELBOW)
# ══════════════════════════════════════════════════════════════════════════════
story.append(KeepTogether([
    header_bar("6.  PULLED ELBOW (NURSEMAID'S ELBOW)", PURPLE),
    Spacer(1, 0.15*cm),
]))

pe_rows = [
    ["Age", "< 5 years (radial head small + annular ligament lax)"],
    ["Mechanism", "Axial pull on the child's hand (e.g., pulled over a curb, swinging by hands)"],
    ["Pathology", "Radial head subluxes UNDER the annular ligament of radius"],
    ["Clinical", "Child holds arm in slight flexion + pronation, refuses to use arm, no obvious swelling"],
    ["X-ray", "Usually normal (subluxation, not fracture). Done to exclude fracture."],
    ["Treatment", "Closed reduction: Supination + compression over radial head (or hyperpronation method). IMMEDIATE pain relief after reduction."],
]
story.append(two_col_table(pe_rows, col1_w=3.5*cm))
story.append(Spacer(1, 0.4*cm))

# ══════════════════════════════════════════════════════════════════════════════
# 7. ELBOW DISLOCATION
# ══════════════════════════════════════════════════════════════════════════════
story.append(KeepTogether([
    header_bar("7.  ELBOW DISLOCATION", RED),
    Spacer(1, 0.15*cm),
]))

ed_rows = [
    ["Most Common Type", "Posterior dislocation (both forearm bones displace posteriorly)"],
    ["Age", "Adults and children. Most common dislocation in children."],
    ["Mechanism", "FOOSH with valgus stress"],
    ["Clinical", "Elbow appears shortened, posterior displacement of olecranon, elbow held in flexion, loss of normal triangle of bony points"],
    ["Key Difference from Supracondylar", "Triangle of bony points DISRUPTED (vs. preserved in supracondylar Fx)"],
    ["Complications", "Brachial artery, median/ulnar nerve injury. Associated fractures (medial epicondyle 50%, coronoid, radial head)."],
    ["Treatment", "Closed reduction under sedation. Immobilize in 90° for 2–3 weeks, then physiotherapy."],
]
story.append(two_col_table(ed_rows, col1_w=4.0*cm))
story.append(Spacer(1, 0.4*cm))

# ══════════════════════════════════════════════════════════════════════════════
# MNEMONIC / MEMORY AIDS PAGE
# ══════════════════════════════════════════════════════════════════════════════
story.append(header_bar("🧠  MNEMONICS & MEMORY AIDS", PURPLE))
story.append(Spacer(1, 0.2*cm))

# CRITOE box
critoe_items = [
    Paragraph("<b>CRITOE</b> — Ossification centres of elbow (order of appearance)", 
              ParagraphStyle("mn_hdr", fontSize=10, fontName="Helvetica-Bold", textColor=PURPLE, leading=15)),
    Spacer(1, 0.1*cm),
    Paragraph(
        "<b>C</b>apitulum (1 yr) &nbsp; <b>R</b>adial head (5 yrs) &nbsp; <b>I</b>nternal epicondyle (5 yrs) &nbsp; "
        "<b>T</b>rochlea (11 yrs) &nbsp; <b>O</b>lecranon (12 yrs) &nbsp; <b>E</b>xternal epicondyle (13 yrs)",
        ParagraphStyle("critoe", fontSize=9.5, fontName="Helvetica", textColor=BLACK, leading=15)),
    Spacer(1, 0.05*cm),
    Paragraph("Rule: If a centre appears in the wrong order on X-ray → suspect avulsion fracture!",
              note_style),
]
story.append(info_box(critoe_items, bg=LPURPLE, border_color=PURPLE))
story.append(Spacer(1, 0.2*cm))

# Nerve injuries box
nerve_data = [
    ["Supracondylar Fx", "AIN (anterior interosseous nerve) — branch of median", "Cannot make 'OK' sign"],
    ["Medial Epicondyle Fx", "Ulnar nerve", "Claw hand, sensory loss medial 1½ fingers"],
    ["Lateral Condyle Fx (late)", "Ulnar nerve (tardy)", "Late progressive claw hand"],
    ["Radial Head Fx", "Posterior interosseous nerve (PIN)", "Wrist/finger drop"],
    ["Elbow Dislocation", "Median or ulnar nerve", "Variable"],
]
story.append(Paragraph("<b>Nerve Injuries — Quick Reference</b>", bold_body))
nerve_table = three_col_table(
    nerve_data,
    widths=[4.0*cm, 6.5*cm, doc.width-4.0*cm-6.5*cm],
    header_row=["Fracture", "Nerve at Risk", "Deficit"],
    bg_header=PURPLE
)
story.append(nerve_table)
story.append(Spacer(1, 0.2*cm))

# Bony points box
bp_items = [
    Paragraph("<b>Triangle of Bony Points</b> (medial epicondyle, lateral epicondyle, olecranon tip)", bold_body),
    bullet("Elbow <b>extended</b>: Three points form a <b>straight horizontal line</b>"),
    bullet("Elbow <b>flexed 90°</b>: Three points form an <b>isosceles triangle</b>"),
    bullet("<b>Supracondylar Fx:</b> Triangle PRESERVED (fracture above epicondyles)"),
    bullet("<b>Elbow Dislocation:</b> Triangle DISRUPTED (bones displaced)"),
]
story.append(info_box(bp_items, bg=LGREEN, border_color=GREEN))
story.append(Spacer(1, 0.2*cm))

# Volkmann box
vic2_items = [
    Paragraph("<b>Volkmann's Ischaemic Contracture — 5 Ps of Compartment Syndrome</b>", bold_body),
    Paragraph(
        "<b>P</b>ain (on passive extension of fingers) &nbsp;|&nbsp; "
        "<b>P</b>allor &nbsp;|&nbsp; <b>P</b>ulselessness &nbsp;|&nbsp; "
        "<b>P</b>araesthesia &nbsp;|&nbsp; <b>P</b>aralysis",
        ParagraphStyle("5ps", fontSize=9.5, fontName="Helvetica", textColor=BLACK, leading=16)
    ),
    Paragraph("Late deformity: Wrist flexion + finger flexion + forearm pronation (flexor ischaemia)", note_style),
]
story.append(info_box(vic2_items, bg=LRED, border_color=RED))
story.append(Spacer(1, 0.4*cm))

# ══════════════════════════════════════════════════════════════════════════════
# COMPARISON TABLE
# ══════════════════════════════════════════════════════════════════════════════
story.append(header_bar("📊  SUPRACONDYLAR Fx  vs  ELBOW DISLOCATION  vs  LATERAL CONDYLE Fx", DGREY))
story.append(Spacer(1, 0.15*cm))

compare_rows = [
    ["Age", "Children 5–10 yrs", "Any age", "Children 5–10 yrs"],
    ["Mechanism", "FOOSH (extension)", "FOOSH + valgus", "FOOSH + varus"],
    ["Deformity", "S-shaped", "Posterior prominence", "Lateral swelling"],
    ["Bony Triangle", "PRESERVED", "DISRUPTED", "Preserved (usually)"],
    ["Nerve at Risk", "AIN (median branch)", "Median / Ulnar", "Ulnar (late)"],
    ["Main Complication", "Volkmann's, cubitus varus", "Associated fractures", "Non-union, cubitus valgus"],
    ["X-ray", "Oblique fracture line above epicondyles", "Posterior displacement both bones", "Fracture lateral condyle"],
]
compare = Table(
    [[Paragraph(f, ParagraphStyle("ch", fontSize=8.5, fontName="Helvetica-Bold", textColor=WHITE, alignment=TA_CENTER))]
     for f in ["Feature", "Supracondylar Fx", "Elbow Dislocation", "Lateral Condyle Fx"]],
    colWidths=[0]*4
)
# Build as proper table
header = ["Feature", "Supracondylar Fx", "Elbow Dislocation", "Lateral Condyle Fx"]
w_c = [3.2*cm, 4.6*cm, 4.6*cm, doc.width-3.2*cm-4.6*cm-4.6*cm]
comp_data = [[Paragraph(h, table_header_style) for h in header]]
for row in compare_rows:
    comp_data.append([Paragraph(c, body_style) for c in row])
comp_t = Table(comp_data, colWidths=w_c)
comp_t.setStyle(TableStyle([
    ("BACKGROUND",   (0,0), (-1,0), DGREY),
    ("GRID",         (0,0), (-1,-1), 0.4, colors.HexColor("#CBD5E1")),
    ("TOPPADDING",   (0,0), (-1,-1), 4),
    ("BOTTOMPADDING",(0,0), (-1,-1), 4),
    ("LEFTPADDING",  (0,0), (-1,-1), 5),
    ("RIGHTPADDING", (0,0), (-1,-1), 5),
    ("VALIGN",       (0,0), (-1,-1), "MIDDLE"),
    ("ROWBACKGROUNDS",(0,1),(-1,-1), [WHITE, GREY]),
    ("FONTNAME",     (0,1), (0,-1), "Helvetica-Bold"),
]))
story.append(comp_t)
story.append(Spacer(1, 0.4*cm))

# ══════════════════════════════════════════════════════════════════════════════
# FAT PAD SIGN
# ══════════════════════════════════════════════════════════════════════════════
story.append(KeepTogether([
    header_bar("🔍  FAT PAD SIGN (X-ray)", colors.HexColor("#1D4ED8")),
    Spacer(1, 0.15*cm),
    info_box([
        Paragraph("<b>Anterior fat pad</b>: Normally visible as a thin lucent stripe — NOT significant alone.", body_style),
        bullet("<b>Elevated anterior fat pad</b> = may indicate effusion"),
        bullet("<b>Posterior fat pad sign</b> = ALWAYS abnormal = haemarthrosis = occult intra-articular fracture"),
        bullet("Seen on lateral X-ray of elbow in 90° flexion"),
        bullet("Most commonly indicates radial head fracture in adults, supracondylar fracture in children"),
        Paragraph("<i>Even if no fracture line visible, positive fat pad sign = treat as fracture!</i>", note_style),
    ], bg=LBLUE, border_color=BLUE),
]))
story.append(Spacer(1, 0.4*cm))

# ══════════════════════════════════════════════════════════════════════════════
# FOOTER
# ══════════════════════════════════════════════════════════════════════════════
story.append(HRFlowable(width="100%", thickness=0.5, color=DGREY))
story.append(Spacer(1, 0.1*cm))
story.append(Paragraph(
    "Sources: Gray's Anatomy for Students | S Das Manual on Clinical Surgery (13th Ed.) | Campbell's Operative Orthopaedics (15th Ed. 2026) — For 1st Year MBBS Quick Revision",
    footer_style))

# ── BUILD PDF ──────────────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF created: {OUTPUT}")

cd /home/daytona/workspace/elbow-revision && python generate_pdf.py 2>&1

ls -lh /home/daytona/workspace/elbow-revision/Elbow_Joint_Fractures_Revision.pdf