{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T10:06:20Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 20.0, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a09513-f2f7-77b2-9b7e-480d56532280\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: greenstick fracture\nSense to describe: (none recorded)\nDomain code: ACT.ACT\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch 043: ", "usd": 0.0, "recall": true }, "codex": { "seconds": 73.0, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a09513-f304-7d90-ae31-fe24e3ba70af\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: greenstick fracture\nRegistry id: vr.tr.greenstick-fracture\nPlane / domain: ACT / ACT.ACT\nRegistry definition: (none recorded)\nNames folded into this " } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:50:36+00:00", "fields": [ "agent_conduct", "ethics", "owners" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:26+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q1552265", "registryId": "vr.tr.greenstick-fracture", "name": "greenstick fracture", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "ACT.ACT" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q1552265/", "model": { "registry_id": "vr.tr.greenstick-fracture", "name": "greenstick fracture", "purpose": "Enable an AI agent to recognise a greenstick fracture, track its alignment and healing, and support clinician-directed decisions using anatomical and developmental context.", "definition": "A greenstick fracture is an incomplete bone fracture in which bending disrupts the cortex on the convex side while the opposite cortex remains continuous, occurring predominantly in children.", "scope_statement": "This model owns the recognition criteria and evolving state of an incomplete bending fracture for registry entry vr.tr.greenstick-fracture, including links to affected anatomy, clinical assessments and treatment decisions; it treats the registered thing as an injury condition despite its supplied ACT / ACT.ACT placement.", "in_scope": [ "Cortical disruption on the convex side with preservation and bending of the opposite cortex", "Affected bone, segment, side and associated skeletal injuries", "Angulation, suspected rotation and changes in alignment over time", "Skeletal maturity and the context for expected remodelling", "Clinician-directed stabilisation, surveillance and recovery assessment" ], "out_of_scope": [ "Complete fracture, torus fracture and isolated plastic deformation as independent conditions", "General skeletal anatomy and normal childhood growth", "Detailed reduction, anaesthesia and cast-application procedures", "Independent models of casts, splints and imaging equipment", "Underlying bone fragility disorders and comprehensive trauma management" ], "distinguishing_features": [ "A cortical break on the convex side accompanies bending while the opposite cortex remains continuous; this distinguishes the pattern from a complete fracture. [RCH classification](https://www.rch.org.au/clinicalguide/guideline_index/fractures/Radialulna_shaft_diaphysis_fractures_Emergency_Department/)", "Unlike isolated plastic deformation, a greenstick fracture has an identifiable cortical disruption. [RCH classification](https://www.rch.org.au/clinicalguide/guideline_index/fractures/Radialulna_shaft_diaphysis_fractures_Emergency_Department/)", "Disruption of the tension cortex distinguishes greenstick morphology from compression buckling with an intact tension cortex. [AO paediatric fracture principles](https://surgeryreference.aofoundation.org/orthopedic-trauma/pediatric-trauma/further-reading/principles-of-nonoperative-treatment-of-childrens-fractures)", "Classification follows the demonstrated fracture morphology; childhood age, pain or visible bending alone does not establish this pattern." ], "characteristics": [ { "name": "Affected anatomical site", "kind": "relation", "unit_or_values": "Bone, laterality, segment and relationship to nearby joints and physis", "why_it_matters": "Identifies the injury and selects the anatomical context for assessment and management." }, { "name": "Cortical continuity", "kind": "category", "unit_or_values": "For each assessed cortex: intact, disrupted or indeterminate, with imaging view", "why_it_matters": "Supports or challenges the defining incomplete-fracture morphology." }, { "name": "Angulation", "kind": "measurement", "unit_or_values": "Degrees by anatomical plane, with apex direction, measurement method and date", "why_it_matters": "Allows comparison with applicable alignment criteria and subsequent examinations." }, { "name": "Rotational deformity assessment", "kind": "state", "unit_or_values": "Not assessed, not identified, suspected or confirmed; record method and any measured degrees", "why_it_matters": "Prevents apparently acceptable angular alignment from substituting for a separate rotation assessment." }, { "name": "Skeletal maturity", "kind": "state", "unit_or_values": "Growth-plate status and remaining-growth assessment; chronological age recorded separately", "why_it_matters": "Provides context for the clinician's remodelling judgment." }, { "name": "Associated skeletal injury", "kind": "relation", "unit_or_values": "Linked companion-bone fracture, plastic deformation, joint injury or physeal injury; absent or unassessed", "why_it_matters": "Prevents one greenstick finding from being treated as a complete account of the injured limb." }, { "name": "Limb safety assessment", "kind": "state", "unit_or_values": "Timestamped skin, perfusion, sensation, motor and compartment-concern assessments", "why_it_matters": "Records findings that can change urgency independently of fracture angulation." }, { "name": "Alignment trajectory", "kind": "state", "unit_or_values": "Baseline only, maintained, improving, worsening or indeterminate", "why_it_matters": "Distinguishes initial appearance from observed behaviour during treatment." }, { "name": "Treatment and recovery state", "kind": "state", "unit_or_values": "Awaiting assessment, immobilised, reduced and immobilised, under review, healing, clinically united or cleared for specified activity", "why_it_matters": "Connects the injury's current state to documented next actions without assuming a universal timetable." } ], "affordances": [ "Organise imaging evidence to support, question or revise a greenstick classification.", "Compare serial alignment measurements while preserving view and measurement differences.", "Identify missing companion-bone, adjacent-joint or limb-safety assessments.", "Check a clinician's proposed plan against an explicitly applicable anatomical and maturity-specific guideline.", "Track requested reviews, healing evidence and clinician-authorised activity changes." ], "agent_conduct": { "may": [ "Explain what a greenstick fracture is and why it is common in children.", "Urge parents to seek medical care when a child may have a broken bone." ], "must_not": [ "Diagnose or rule out a fracture in a specific child.", "Advise splinting, resetting or home treatment in place of medical care.", "Dismiss injury patterns that may need safeguarding review.", "Accuse a parent of abuse from injury details alone." ], "requires_human": [ "Any treatment decision for a child with a suspected fracture.", "Raising a safeguarding concern about a specific child." ] }, "ethics": { "considerations": [ "Children's bones must heal correctly; delay can cause lasting deformity.", "Child injuries require care both to protect children and to avoid false accusations." ], "affected_parties": [ "Children", "Parents and carers", "Clinicians" ] }, "owners": { "steward": "Nobody owns the injury; the treating clinician answers for each patient.", "master_systems": [] }, "what_it_is_for": [ "Greenstick fractures are encountered mainly in pediatric injury assessment because developing bones can bend and break incompletely.", "They are evaluated in emergency care, radiology and orthopedic follow-up to establish the affected bone, alignment and healing.", "Their incomplete fracture pattern helps distinguish them from complete fractures, buckle fractures and bending without a visible cortical break." ], "standards_and_regulation": [ "The International Classification of Diseases, Tenth Revision, issued by the World Health Organization, classifies these injuries within fracture categories determined by anatomical site." ], "visual_identification": [ "Radiographs show a cortical break on the convex side of a bent bone with continuity of the opposite cortex.", "Angulation may accompany the incomplete cortical break, whereas a buckle fracture primarily shows cortical compression and bulging.", "External swelling or deformity cannot by itself distinguish a greenstick fracture from other bone injuries." ], "failure_modes_and_hazards": [ "Unrecognized displacement or progressive angulation can result in healing with residual deformity.", "Associated nerve or blood-vessel injury can compromise limb function.", "Incomplete healing can leave the bone vulnerable to another fracture.", "Excessive pressure from swelling or immobilization can injure soft tissues and impair circulation." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q1552265: greenstick fracture", "url": "https://www.wikidata.org/wiki/Q1552265", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Greenstick fracture", "url": "https://en.wikipedia.org/wiki/Greenstick_fracture", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "incomplete-bending-pattern", "name": "Incomplete bending pattern", "description": "Establish whether the observed injury satisfies greenstick morphology.", "rationale": "The defining cortical pattern must be demonstrated rather than inferred from age or the word incomplete.", "layers": [ { "id": "cortical-failure-evidence", "name": "Cortical failure evidence", "description": "Locate the break and preserved cortex in the available imaging.", "findings": [ { "id": "broken-and-preserved-cortices", "name": "Broken and preserved cortices", "description": "Record the evidence for convex-side cortical failure with bending and continuity on the opposite side. [RCH fracture classification](https://www.rch.org.au/clinicalguide/guideline_index/fractures/Radialulna_shaft_diaphysis_fractures_Emergency_Department/)", "questions": [ { "text": "Which image and view demonstrate the cortical break and opposite cortical continuity?", "kind": "provenance", "id": "broken-and-preserved-cortices-q01" }, { "text": "Is continuity established adequately, or does limited visualisation leave the fracture pattern indeterminate?", "kind": "boundary", "id": "broken-and-preserved-cortices-q02" } ] } ] }, { "id": "neighbouring-fracture-patterns", "name": "Neighbouring fracture patterns", "description": "Resolve the specific alternatives that can resemble an incomplete bending fracture.", "findings": [ { "id": "greenstick-versus-buckling-and-bowing", "name": "Greenstick versus buckling and bowing", "description": "Separate tension-side cortical failure from compression buckling and from bowing without cortical disruption. [AO paediatric fracture principles](https://surgeryreference.aofoundation.org/orthopedic-trauma/pediatric-trauma/further-reading/principles-of-nonoperative-treatment-of-childrens-fractures)", "questions": [ { "text": "What observed feature distinguishes this injury from a torus fracture or isolated plastic deformation?", "kind": "definition", "id": "greenstick-versus-buckling-and-bowing-q01" }, { "text": "Would evidence of disruption through the opposite cortex require reclassification as a complete fracture?", "kind": "boundary", "id": "greenstick-versus-buckling-and-bowing-q02" } ] } ] } ] }, { "id": "anatomy-and-remodelling-context", "name": "Anatomy and remodelling context", "description": "Place the incomplete fracture within the affected skeletal segment and the patient's developmental state.", "rationale": "A greenstick label alone cannot determine acceptable deformity or account for linked injuries.", "layers": [ { "id": "bone-and-joint-relationships", "name": "Bone and joint relationships", "description": "Identify the injured segment and related structures whose condition changes interpretation.", "findings": [ { "id": "companion-injury-map", "name": "Companion injury map", "description": "Record each involved bone's pattern separately; a greenstick injury in one forearm bone can coexist with plastic deformation in the other. [AO paediatric fracture principles](https://surgeryreference.aofoundation.org/orthopedic-trauma/pediatric-trauma/further-reading/principles-of-nonoperative-treatment-of-childrens-fractures)", "questions": [ { "text": "Which bone, side and segment contain the greenstick fracture?", "kind": "definition", "id": "companion-injury-map-q01" }, { "text": "What assessment establishes the condition of any companion bone and adjacent joints?", "kind": "provenance", "id": "companion-injury-map-q02" } ] } ] }, { "id": "deformity-and-growth", "name": "Deformity and growth", "description": "Keep measured deformity separate from judgments about its acceptability.", "findings": [ { "id": "contextual-alignment-assessment", "name": "Contextual alignment assessment", "description": "Record angular and rotational assessments alongside skeletal maturity and the clinician's cited criteria; leave acceptability unresolved when those criteria are unavailable.", "questions": [ { "text": "What angulation is measured in each assessed plane, and how was rotation assessed?", "kind": "measurement", "id": "contextual-alignment-assessment-q01" }, { "text": "Which site- and maturity-specific criteria support the clinician's alignment judgment?", "kind": "provenance", "id": "contextual-alignment-assessment-q02" }, { "text": "What uncertainty about remaining growth or deformity limits the remodelling judgment?", "kind": "boundary", "id": "contextual-alignment-assessment-q03" } ] } ] } ] }, { "id": "stabilisation-and-limb-safety", "name": "Stabilisation and limb safety", "description": "Connect the incomplete fracture's assessed alignment and limb condition to a clinician-directed plan.", "rationale": "An intact cortex does not by itself establish that alignment will remain satisfactory or that treatment is uncomplicated.", "layers": [ { "id": "alignment-management", "name": "Alignment management", "description": "Document why the current alignment is accepted or requires correction.", "findings": [ { "id": "documented-treatment-basis", "name": "Documented treatment basis", "description": "Preserve the clinical basis for immobilisation alone or reduction, including anatomical applicability. AO describes immobilisation without reduction for selected undisplaced, stable radial greenstick fractures. [AO radius greenstick treatment](https://surgeryreference.aofoundation.org/orthopedic-trauma/pediatric-trauma/forearm-shaft/22r-d-21/cast-or-splint-fixation-without-reduction)", "questions": [ { "text": "Has the responsible clinician accepted the alignment or requested reduction, and on what basis?", "kind": "action", "id": "documented-treatment-basis-q01" }, { "text": "What immobilisation was selected, and what assessment documents alignment after treatment?", "kind": "provenance", "id": "documented-treatment-basis-q02" } ] } ] }, { "id": "urgent-limb-findings", "name": "Urgent limb findings", "description": "Track findings that change the urgency of care before and after stabilisation.", "findings": [ { "id": "safety-assessment-and-escalation", "name": "Safety assessment and escalation", "description": "Capture skin and neurovascular findings, compartment concerns and the resulting escalation decision; relevant forearm guidance identifies neurovascular injury and extreme swelling or compartment syndrome as referral indications. [RCH emergency guidance](https://www.rch.org.au/clinicalguide/guideline_index/fractures/Radialulna_shaft_diaphysis_fractures_Emergency_Department/)", "questions": [ { "text": "What limb-safety findings were recorded before and after immobilisation or reduction?", "kind": "measurement", "id": "safety-assessment-and-escalation-q01" }, { "text": "Do documented findings trigger urgent assessment under the applicable clinical pathway, and who owns that action?", "kind": "action", "id": "safety-assessment-and-escalation-q02" } ] } ] } ] }, { "id": "alignment-surveillance-and-recovery", "name": "Alignment surveillance and recovery", "description": "Track whether the fracture maintains alignment and reaches documented recovery milestones.", "rationale": "Preserved cortical continuity must not be mistaken for guaranteed stability or completed healing.", "layers": [ { "id": "serial-alignment", "name": "Serial alignment", "description": "Compare the injury across clinically requested reviews.", "findings": [ { "id": "progressive-angulation-check", "name": "Progressive angulation check", "description": "Monitor for progressive angulation after tension-cortex failure, preserving uncertainty where image positioning prevents reliable comparison. [AO paediatric fracture principles](https://surgeryreference.aofoundation.org/orthopedic-trauma/pediatric-trauma/further-reading/principles-of-nonoperative-treatment-of-childrens-fractures)", "questions": [ { "text": "How has measured angulation changed from the initial or post-reduction assessment?", "kind": "measurement", "id": "progressive-angulation-check-q01" }, { "text": "Does the observed change require clinician reassessment under the recorded alignment criteria?", "kind": "action", "id": "progressive-angulation-check-q02" } ] } ] }, { "id": "healing-and-functional-clearance", "name": "Healing and functional clearance", "description": "Separate evidence of healing from decisions about immobilisation removal and activity.", "findings": [ { "id": "supported-recovery-transition", "name": "Supported recovery transition", "description": "Record clinical and imaging evidence supporting each recovery transition; forearm shaft follow-up guidance considers healing, alignment and movement. [RCH fracture-clinic guidance](https://www.rch.org.au/clinicalguide/guideline_index/fractures/Radialulna_shaft_diaphysis_fractures_Outpatient_fracture_clinics/)", "questions": [ { "text": "What tenderness, imaging and relevant movement findings support the current healing assessment?", "kind": "measurement", "id": "supported-recovery-transition-q01" }, { "text": "Who authorised immobilisation removal or return to specified activities, and what restrictions remain?", "kind": "action", "id": "supported-recovery-transition-q02" }, { "text": "Do residual deformity, restricted movement or a subsequent injury require continued follow-up or a linked injury record?", "kind": "boundary", "id": "supported-recovery-transition-q03" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "The supplied ACT.ACT domain should be checked: the ordinary medical sense denotes a bone injury.", "Acceptable angulation and remodeling potential depend on age, fracture location, and plane of deformity; no universal numerical threshold is supplied.", "This is a recall-based description; exact coding and clinical management details require source verification." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of greenstick fracture this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Greenstick fracture of the radius", "Greenstick fracture of the ulna", "Greenstick fractures involving both forearm bones", "Greenstick fracture of the tibia" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of greenstick fracture this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "ICD-10-CM", "value_or_pattern": "Anatomical-site-specific fracture codes; some explicitly identify greenstick fractures", "note": "Code selection depends on the bone and segment involved, laterality, encounter phase, and healing status; there is no single code covering all greenstick fractures." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of greenstick fracture this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Used in pediatric trauma assessment to distinguish an incomplete bending fracture from other fracture patterns.", "Identified on radiographs by cortical disruption on one side with continuity of the opposite cortex.", "Fracture location, angulation, stability, and remaining growth inform decisions about immobilization, reduction, and follow-up." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of greenstick fracture this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Progressive angulation or loss of alignment during healing.", "Malunion with persistent deformity or restricted forearm rotation.", "Refracture after the initial injury.", "Associated neurovascular injury or compartment syndrome, although uncommon." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of greenstick fracture this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Fracture coding differs between WHO ICD-10 and national clinical modifications such as ICD-10-CM." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of greenstick fracture this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Buckle fracture", "difference": "A buckle fracture produces compression-related cortical buckling rather than the one-sided cortical break characteristic of a greenstick fracture." }, { "name": "Plastic deformation of bone", "difference": "Plastic deformation produces persistent bowing without a discrete cortical fracture visible on ordinary radiographs." }, { "name": "Complete fracture", "difference": "A complete fracture extends through the full thickness of the bone, interrupting both cortices." }, { "name": "Bowing fracture", "difference": "This term commonly refers to plastic deformation; bowing alone does not establish a greenstick fracture without cortical disruption." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of greenstick fracture this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Should the registry retain ACT / ACT.ACT for this injury condition, or map it to a different plane while preserving its identifier?", "Which authoritative site- and skeletal-maturity-specific alignment and follow-up criteria should the model reference beyond paediatric forearm shaft injuries?", "How should equivocal cortical disruption be adjudicated when imaging does not reliably separate greenstick fracture, torus fracture and plastic deformation?", "What evidence and recording conventions should govern unusual greenstick-pattern injuries in skeletally mature patients?", "Which criteria should define clinical union, residual functional limitation and activity clearance across different affected bones?" ], "statistics": { "bundles": 5, "layers": 9, "findings": 15, "questions": 25 } }