const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "MS Orthopaedics 2026";
pres.title = "Supracondylar Fracture Humerus - Management Algorithms & Complications";

// ─── COLOUR PALETTE ──────────────────────────────────────────────
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// ─── SLIDE 1: TITLE ──────────────────────────────────────────────
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    x: 0.5, y: 0.7, w: 9, h: 1.8,
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    { text: "Sources: ", options: { bold: true } },
    { text: "Campbell's Operative Orthopaedics 15th Ed 2026  |  Rosen's Emergency Medicine  |  Tintinalli  |  Bailey & Love 28th Ed" }
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// ─── SLIDE 2: OVERVIEW / HIGH-YIELD FACTS ────────────────────────
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  addHeader(s, "High-Yield Overview", "MS Orthopaedics Exam Essentials");

  const facts = [
    ["Most common elbow fracture in children", "60% of all paediatric elbow injuries"],
    ["Peak incidence", "Ages 5–7 years"],
    ["Extension type", "97–98% of all cases"],
    ["Mechanism", "FOOSH — Fall on Outstretched Hand with hyperextension"],
    ["Key nerve at risk", "Anterior Interosseous Nerve (AIN) → pointing index sign"],
    ["Key vessel at risk", "Brachial artery (Type III posterolateral)"],
    ["Classification", "Gartland Types I / IIA / IIB / III / IV"],
    ["Dreaded complication", "Volkmann Ischaemic Contracture"],
    ["Most common late complication", "Cubitus Varus (Gunstock Deformity)"],
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  addFooter(s, "Campbell's Operative Orthopaedics 15th Ed 2026 | Rosen's Emergency Medicine");
}

// ─── SLIDE 3: GARTLAND CLASSIFICATION ───────────────────────────
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  addHeader(s, "Gartland Classification — Extension Type Supracondylar Fracture",
    "Modified Gartland Classification | Campbell's Operative Orthopaedics 15th Ed 2026");

  const types = [
    { type: "Type I", color: C.green,       desc: "Undisplaced / ≤2 mm displacement\nPosterior fat pad sign may be only finding", rx: "Posterior fat pad sign present", tx: "Long-arm cast 3 weeks\nElbow 90° flexion, forearm neutral" },
    { type: "Type IIA", color: "2471A3",    desc: "Angulated, posterior cortex intact\nStable — no rotational deformity", rx: "AHL misses mid-capitellum", tx: "Closed reduction + above-elbow cast" },
    { type: "Type IIB", color: "D68910",    desc: "Posterior cortex intact\nUnstable — rotation / coronal angulation", rx: "AHL misses mid-capitellum\nBaumann angle abnormal", tx: "Closed reduction + percutaneous K-wires\n(2–3 lateral pins)" },
    { type: "Type III", color: C.red,       desc: "Complete displacement\nNo cortical contact", rx: "Complete fracture through olecranon fossa\nNeurovascular injury risk HIGH", tx: "CRPP — Closed Reduction +\nPercutaneous Pinning (URGENT)" },
    { type: "Type IV", color: "6C3483",     desc: "Periosteal hinge disrupted\nUnstable in BOTH flexion & extension", rx: "High-energy trauma\nComplete soft tissue disruption", tx: "CRPP or ORIF\nVascular exploration if pulseless" },
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  addFooter(s, "Gartland Classification | Campbell's Operative Orthopaedics 15th Ed 2026, Table 38.2");
}

// ─── SLIDE 4: RADIOLOGICAL ASSESSMENT ───────────────────────────
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    "AP + Lateral + Oblique Views | Critical for Diagnosis and Grading");

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      points: [
        "Draw line along ANTERIOR cortex of humerus on lateral X-ray",
        "Normally intersects the MIDDLE THIRD of capitellum",
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        "  → Line passes through anterior 1/3 or ANTERIOR to capitellum",
        "  → Capitellum is displaced posteriorly",
        "Most sensitive sign for subtle Type I/II fractures"
      ]
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      points: [
        "Measured on AP view",
        "Angle between: capitellar physis line ∠ long axis of humerus",
        "Normal: 70–75 degrees",
        "Used to: detect fractures, assess adequacy of reduction",
        "Compare with contralateral side always",
        "Asymmetric Baumann angle = malreduction"
      ]
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    {
      name: "Fat Pad Signs (Lateral View)",
      color: "9B59B6",
      points: [
        "POSTERIOR fat pad = ALWAYS pathological",
        "  → Indicates haemarthrosis / effusion",
        "  → Suggests occult fracture even if fracture line invisible",
        "ANTERIOR fat pad 'SAIL SIGN':",
        "  → Abnormal when bulging/elevated anterior to coronoid fossa",
        "Type I fractures: fat pad sign may be ONLY finding"
      ]
    },
    {
      name: "CRITOE — Ossification Order",
      color: C.navy,
      points: [
        "C — Capitellum  (6–12 months)",
        "R — Radial head  (4–5 years)",
        "I  — Internal (medial) epicondyle  (5–7 years)",
        "T — Trochlea  (9–10 years)",
        "O — Olecranon  (9–10 years)",
        "E — External (lateral) epicondyle  (10–12 years)"
      ]
    }
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    { x: 5.1,  y: 3.3, w: 4.65, h: 2.1 },
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    });
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  addFooter(s, "Rosen's Emergency Medicine p. 3304–3305 | Tintinalli's Emergency Medicine");
}

// ─── SLIDE 5: MANAGEMENT ALGORITHM (OVERALL) ────────────────────
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  addHeader(s, "Management Algorithm — By Gartland Type",
    "Emergency Assessment → Classification → Definitive Treatment");

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  // Top: Emergency Assessment
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    x: 3.2, y: 1.12, w: 3.6, h: 0.65,
    fill: { color: C.navy }, line: { color: C.navy },
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    fontSize: 11, bold: true, color: C.gold, align: "center", valign: "middle",
    fontFace: "Calibri"
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    x: 3.0, y: 2.07, w: 4.0, h: 0.55,
    fill: { color: C.teal }, line: { color: C.teal }
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    fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri"
  });

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  // Gartland Classification node
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    x: 3.3, y: 2.92, w: 3.4, h: 0.52,
    fill: { color: C.gold }, line: { color: C.gold }
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    x: 3.3, y: 2.92, w: 3.4, h: 0.52,
    fontSize: 12, bold: true, color: C.navy, align: "center", valign: "middle", fontFace: "Calibri"
  });

  // horizontal line
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    { type: "TYPE I", tx: "Long-arm cast\n3 weeks, 90°\nOutpatient F/U", color: C.green },
    { type: "TYPE IIA", tx: "Closed reduction\n+ Above-elbow\ncast 3–4 wks", color: "2471A3" },
    { type: "TYPE IIB\n& TYPE III", tx: "CRPP\n2–3 lateral K-wires\n+ Above-elbow cast", color: C.red },
    { type: "TYPE IV", tx: "CRPP or ORIF\nVascular assessment\nArtery exploration PRN", color: "6C3483" },
  ];

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      x: x + 0.92, y: 3.44, w: 0.08, h: 0.36,
      fill: { color: b.color }, line: { color: b.color }
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      x: x, y: 3.8, w: 2.0, h: 0.45,
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      fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri"
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      x: x, y: 4.25, w: 2.0, h: 1.06,
      fill: { color: C.white }, line: { color: b.color, pt: 1.2 }
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      fontSize: 9.5, color: C.charcoal, fontFace: "Calibri", align: "center", valign: "middle"
    });
  });

  addFooter(s, "Campbell's Operative Orthopaedics 15th Ed 2026 | Bailey & Love's Surgery 28th Ed");
}

// ─── SLIDE 6: VASCULAR INJURY ALGORITHM ─────────────────────────
{
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    x: 0, y: 0, w: 10, h: 5.625, fill: { color: "0A1628" }, line: { color: "0A1628" }
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    x: 0, y: 0, w: 10, h: 1.05, fill: { color: "0D2137" }, line: { color: "0D2137" }
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  s.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 1.0, w: 10, h: 0.07, fill: { color: C.gold }, line: { color: C.gold }
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    x: 0.35, y: 0.1, w: 9.3, h: 0.55,
    fontSize: 20, bold: true, color: C.white, fontFace: "Calibri", margin: 0
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  s.addText("Type III/IV | SURGICAL EMERGENCY — Volkmann Contracture Prevention", {
    x: 0.35, y: 0.64, w: 9.3, h: 0.32,
    fontSize: 11, color: C.gold, fontFace: "Calibri", italic: true, margin: 0
  });

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      x, y, w, h, fill: { color: fill }, line: { color: fill },
      shadow: { type: "outer", color: "000000", blur: 6, offset: 3, angle: 135, opacity: 0.3 }
    });
    slide.addText(text, {
      x: x + 0.05, y, w: w - 0.1, h,
      fontSize: fontSize || 10, bold: true, color: textColor || C.white,
      fontFace: "Calibri", align: "center", valign: "middle"
    });
  }

  function arrow(slide, x1, y1, x2, y2, color) {
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      slide.addShape(pres.shapes.RECTANGLE, {
        x: x1 - 0.04, y: y1, w: 0.08, h: y2 - y1,
        fill: { color: color || C.teal }, line: { color: color || C.teal }
      });
    } else {
      slide.addShape(pres.shapes.RECTANGLE, {
        x: Math.min(x1, x2), y: y1, w: Math.abs(x2 - x1), h: 0.07,
        fill: { color: color || C.teal }, line: { color: color || C.teal }
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  // Top: Pulseless hand
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  // Arrow down
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  // Reduce + pin
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  // Arrow → split left/right
  arrow(s, 5.0, 2.57, 5.0, 2.78);
  // horizontal
  arrow(s, 2.2, 2.82, 7.8, 2.82);
  // left vertical down
  arrow(s, 2.2, 2.82, 2.2, 3.1);
  // right vertical down
  arrow(s, 7.8, 2.82, 7.8, 3.1);

  // Left branch: ADEQUATE PERFUSION (pink pulseless)
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  arrow(s, 2.17, 3.62, 2.17, 3.88);
  flowBox(s, 0.35, 3.88, 3.65, 0.72,
    "Observe in 45° elbow flexion\nDO NOT hyperflexe\nPulse returns in 24–48 hr in most cases\nMonitor hourly neurovascular obs", "155A35", C.white, 8.5);

  // Right branch: DYSVASCULAR
  flowBox(s, 5.95, 3.1, 3.6, 0.52, "DYSVASCULAR HAND\n(Absent perfusion, pallor, cold)", C.red, C.white, 9);
  arrow(s, 7.75, 3.62, 7.75, 3.88);
  flowBox(s, 5.95, 3.88, 3.6, 0.72,
    "Explore brachial artery\n(Anterior approach)\nRepair / vein graft\nFasciotomy if compartment syndrome\nPrepare saphenous vein graft", "8B0000", C.white, 8.5);

  // Warning box at bottom
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    x: 0.3, y: 4.68, w: 9.4, h: 0.62,
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  s.addText([
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  ], {
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  addFooter(s, "Campbell's Operative Orthopaedics 15th Ed 2026, Fig. 38.11 | Bailey & Love 28th Ed p. 462");
}

// ─── SLIDE 7: NERVE INJURY MANAGEMENT ───────────────────────────
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  addHeader(s, "Neurological Complications — Assessment & Management",
    "Neuropraxia is most common; assessment is MANDATORY before reduction");

  const nerves = [
    {
      nerve: "Anterior Interosseous Nerve (AIN)",
      freq: "Most Common",
      freqColor: C.red,
      assoc: "Type III posterolateral displacement",
      test: "Ask patient to make 'OK sign'\nAIN paralysis → cannot flex thumb IP + index DIP\n→ 'Pointing index / pointing finger sign'",
      tx: "Neuropraxia in most cases\nObserve after fracture reduction\n90%+ resolve within 3–6 months\nEMG at 3 months if no recovery",
      color: C.red
    },
    {
      nerve: "Radial Nerve",
      freq: "Second Most Common",
      freqColor: "D68910",
      assoc: "Posteromedial (Type IIIa) displacement",
      test: "Test wrist extension\nFinger (MCP) extension\nSensation dorsal first web space",
      tx: "Neuropraxia — observe\nResolves with fracture stabilisation\nExplore only if no recovery at 3 months",
      color: "D68910"
    },
    {
      nerve: "Median Nerve",
      freq: "Less Common",
      freqColor: C.teal,
      assoc: "Posterolateral (Type IIIb) displacement",
      test: "Sensation — index finger tip / radial palm\nThenar wasting (chronic)\nWeakness thumb opposition",
      tx: "Neuropraxia — observe\nResolves after reduction\nRarely requires surgical exploration",
      color: C.teal
    },
    {
      nerve: "Ulnar Nerve",
      freq: "Iatrogenic Risk",
      freqColor: "6C3483",
      assoc: "Flexion type fractures OR medial pin placement",
      test: "Sensation — little finger / ulnar palm\nIntrinsic hand power\nFroment's sign",
      tx: "AVOID medial pin without direct visualization\nIatrogenic injury from medial K-wire\nUse lateral pins ONLY for Type II fractures",
      color: "6C3483"
    },
  ];

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      align: "center", valign: "middle", margin: 0
    });
    s.addText([
      { text: "Associated with: ", options: { bold: true, color: C.teal } },
      { text: n.assoc, options: { color: C.charcoal } },
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    s.addText([
      { text: "Test: ", options: { bold: true, color: C.navy } },
      { text: n.test, options: { color: C.charcoal } }
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    s.addText([
      { text: "Management: ", options: { bold: true, color: C.green } },
      { text: n.tx, options: { color: C.charcoal } }
    ], { x: x + 0.15, y: y + 1.44, w: w - 0.25, h: 0.48, fontSize: 8.5, fontFace: "Calibri", margin: 0 });
  });

  addFooter(s, "Tintinalli's Emergency Medicine | Campbell's Operative Orthopaedics 15th Ed 2026");
}

// ─── SLIDE 8: COMPLICATIONS — EARLY ─────────────────────────────
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  });
  addHeader(s, "Early Complications", "Incidence | Mechanism | Recognition | Management");

  const earlyComps = [
    {
      name: "Vascular Injury", icon: "🩸",
      incidence: "~1–2% of displaced fractures",
      mechanism: "Brachial artery kinking/laceration by proximal fragment",
      recognition: "5 Ps: Pain, Pallor, Pulselessness, Paralysis, Paraesthesias\nWhite hand = emergency; Pink pulseless = observe",
      management: "Urgent CRPP → if no pulse returns → brachial artery exploration ± vein graft",
      color: C.red
    },
    {
      name: "Nerve Injury", icon: "⚡",
      incidence: "~10–16% of fractures",
      mechanism: "Traction / compression neuropraxia on reduction\nAIN most common; radial nerve in Type IIIa",
      recognition: "Detailed motor-sensory exam pre-op\nPointing index sign (AIN), wrist drop (radial)",
      management: "90%+ resolve with fracture stabilisation\nEMG/NCS at 3 months if no recovery",
      color: "2471A3"
    },
    {
      name: "Compartment Syndrome", icon: "⚠",
      incidence: "0.1–0.3%",
      mechanism: "Post-reduction swelling, tight cast, hyperflexion\nMore common with concurrent forearm/wrist fracture",
      recognition: "Paediatric 3 As: Agitation, Anxiety, increasing Analgesia\nMeasure compartment pressure if suspected",
      management: "Urgent fasciotomy (all 4 forearm compartments)\nNEVER use hyperflexed position if significant swelling",
      color: C.gold
    },
    {
      name: "Volkmann's Ischaemic Contracture", icon: "🔴",
      incidence: "Rare but DREADED",
      mechanism: "Missed compartment syndrome → forearm flexor fibrosis\nResults from prolonged ischaemia > 6–8 hours",
      recognition: "Late: Fixed flexion deformity of wrist + fingers\nIntrinsic plus hand deformity in severe cases",
      management: "Prevention is key!\nTreatment: physiotherapy (mild), muscle slide / Z-plasty (moderate), free muscle transfer (severe)",
      color: "6C3483"
    },
  ];

  earlyComps.forEach((c, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
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    const y = 1.2 + row * 2.1;
    const w = 4.75;
    const h = 2.0;
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    });
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  addFooter(s, "Campbell's Operative Orthopaedics 15th Ed 2026 | Bailey & Love 28th Ed p. 462");
}

// ─── SLIDE 9: COMPLICATIONS — LATE ──────────────────────────────
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  addHeader(s, "Late Complications", "Most Common: Cubitus Varus (Gunstock Deformity) | Malunion");

  // Cubitus varus large feature box
  addCard(s, 0.15, 1.18, 5.8, 2.8, "CUBITUS VARUS — Gunstock Deformity  (Most Common Late Complication)", C.red);

  s.addText([
    { text: "Definition: ", options: { bold: true, color: C.red } },
    { text: "Reversed carrying angle due to medial malunion of distal humerus\n", options: { color: C.charcoal } },
    { text: "Cause: ", options: { bold: true, color: C.navy } },
    { text: "Malunion in varus — failure to restore Baumann angle (most common cause: inadequate reduction of Type II/III)\n", options: { color: C.charcoal } },
    { text: "Clinical features: ", options: { bold: true, color: C.navy } },
    { text: "\"Gunstock\" arm appearance; usually cosmetic deformity; elbow motion usually preserved\n", options: { color: C.charcoal } },
    { text: "Late risks: ", options: { bold: true, color: C.navy } },
    { text: "Posterolateral rotatory instability (PLRI); lateral ulnar collateral ligament laxity; late-onset lateral epicondylalgia\n", options: { color: C.charcoal } },
    { text: "Treatment: ", options: { bold: true, color: C.green } },
    { text: "Corrective supracondylar osteotomy if symptomatic / severe cosmetic concern", options: { color: C.charcoal } },
  ], {
    x: 0.3, y: 1.54, w: 5.55, h: 2.4,
    fontSize: 9.5, fontFace: "Calibri", valign: "top", margin: 0
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  // Right column: other late complications
  const lateOthers = [
    { name: "Cubitus Valgus", detail: "Increased carrying angle\nCause: malunion in valgus (less common)\nComplication: Tardy Ulnar Nerve Palsy (late onset — may present years later)", color: "2471A3" },
    { name: "Elbow Stiffness", detail: "Usually resolves spontaneously\nAvoid aggressive passive mobilisation\nNO FORCEFUL PHYSIOTHERAPY — risk of myositis ossificans", color: C.teal },
    { name: "Myositis Ossificans", detail: "Heterotopic bone formation post-trauma\nTriggered by aggressive passive mobilisation\nTreatment: excision after maturation", color: "D68910" },
    { name: "Avascular Necrosis / Growth Disturbance", detail: "Rare; risk higher with open reduction\nMonitor with serial X-rays\nCapitellar AVN may cause long-term stiffness", color: "6C3483" },
  ];

  lateOthers.forEach((c, i) => {
    const y = 1.18 + i * 1.07;
    addCard(s, 6.1, y, 3.7, 1.0, c.name, c.color);
    s.addText(c.detail, {
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      fontSize: 8.5, color: C.charcoal, fontFace: "Calibri", valign: "top", margin: 0
    });
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  addFooter(s, "Bailey & Love's Surgery 28th Ed | Campbell's Operative Orthopaedics 15th Ed 2026");
}

// ─── SLIDE 10: OPERATIVE TECHNIQUE — K-WIRE FIXATION ────────────
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  addHeader(s, "Percutaneous K-Wire Fixation — Technique & Principles",
    "CRPP — Closed Reduction Percutaneous Pinning | Gold Standard for Type IIB / III / IV");

  // Indications box
  addCard(s, 0.15, 1.18, 3.5, 1.85, "INDICATIONS for CRPP", C.navy);
  const indItems = [
    "Type IIB (rotation/instability)",
    "Type III (complete displacement)",
    "Type IV (periosteal hinge disrupted)",
    "Failed closed reduction + cast alone",
    "Pink/white pulseless hand",
    "Brachialis penetration (pucker sign)"
  ];
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    ["Lateral pins only (2–3):", "PREFERRED for Type IIB\nAvoids ulnar nerve injury\nSlightly less rotational stability"],
    ["Crossed pins (lat + med):", "Better for Type III/IV\nHigher ulnar nerve injury risk\nOnly use medial pin under direct vision"],
  ];
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  });

  // Steps box
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  const steps = [
    ["1. Positioning:", "Supine, arm on radiolucent side table\nImage intensifier (C-arm) available"],
    ["2. Reduction:", "Traction in line → correct rotation first\nElbow flexion to 90° while maintaining reduction\nPronation of forearm (extension type)"],
    ["3. Fluoroscopic check:", "AP: Baumann angle restored (70–75°)\nLateral: AHL intersects middle 1/3 capitellum\nOblique: confirm cortical continuity"],
    ["4. K-wire insertion:", "Enter lateral epicondyle first\n1.6–2.0 mm K-wires x2–3\nDiverge proximally to engage medial cortex\nConfirm stability — no toggling"],
    ["5. Post-op:", "Above-elbow backslab with elbow at 90°\nK-wire removal at 3–4 weeks in clinic\nEarly physiotherapy after pin removal"],
    ["6. Failure — convert to ORIF:", "If closed reduction fails (brachialis interposition)\nNeurovascular injury requiring open exploration"],
  ];
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  addFooter(s, "Campbell's Operative Orthopaedics 15th Ed 2026 | Miller's Review of Orthopaedics 9th Ed");
}

// ─── SLIDE 11: EXAM SUMMARY ──────────────────────────────────────
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    fontSize: 11, color: C.silver, fontFace: "Calibri", align: "center", italic: true
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  const col1 = [
    "Most common elbow fracture in children (age 5–7 yrs)",
    "Extension type = 97–98%; mechanism = FOOSH",
    "Gartland classification: I / IIA / IIB / III / IV",
    "AHL, Baumann angle (70–75°), posterior fat pad sign",
    "CRITOE = order of ossification centre appearance",
    "Most common nerve injury = AIN → pointing index sign",
    "Type I → Long-arm cast 3 weeks",
    "Type IIB/III → CRPP with 2–3 lateral K-wires",
  ];
  const col2 = [
    "White pulseless hand = surgical emergency",
    "Pink pulseless hand = reduce + observe ± explore",
    "Hyperflexion contraindicated if swollen (→ compartment syndrome)",
    "3 As in children = Agitation, Anxiety, Analgesia ↑ → compartment syndrome",
    "Most common late complication = cubitus varus",
    "Dreaded complication = Volkmann's ischaemic contracture",
    "Cubitus valgus → tardy ulnar nerve palsy",
    "No aggressive passive mobilisation → myositis ossificans",
  ];

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  s.addText("Sources: Campbell's Operative Orthopaedics 15th Ed 2026 | Rosen's Emergency Medicine | Tintinalli's Emergency Medicine | Bailey & Love 28th Ed | Miller's Review of Orthopaedics 9th Ed", {
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// ─── WRITE FILE ──────────────────────────────────────────────────
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