{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T11:56:30Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 22.5, "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: 01a09578-94c8-75f2-90a1-4e6d9e0c4829\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: patella 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 044: 100", "usd": 0.0, "recall": true }, "codex": { "seconds": 87.4, "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: 01a09578-94bc-7ae2-9f7c-110c8b94ddf9\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: patella fracture\nRegistry id: vr.tr.patella-fracture\nPlane / domain: ACT / ACT.ACT\nRegistry definition: (none recorded)\nNames folded into this entry:" } }, "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-Q1680525", "registryId": "vr.tr.patella-fracture", "name": "patella fracture", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "ACT.ACT" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q1680525/", "model": { "registry_id": "vr.tr.patella-fracture", "name": "patella fracture", "purpose": "Enable an agent to recognise a patella fracture, record its structural and functional severity, and support clinician-directed treatment and recovery decisions.", "definition": "A patella fracture is a break in the kneecap that may disrupt its articular surface, the knee extensor mechanism, or both.", "scope_statement": "This model owns the injury episode and evolving fracture state of the patella under registry entry vr.tr.patella-fracture, preserving its ACT / ACT.ACT assignment while distinguishing the condition from the injury event and treatment activities.", "in_scope": [ "Evidence confirming or excluding fracture of the patella", "Fracture location, pattern, fragment displacement and articular involvement", "Knee extension function and associated soft-tissue injury", "Open-wound status and fracture-specific urgency", "Treatment rationale, protection requirements and reassessment", "Healing, functional recovery and attributable complications" ], "out_of_scope": [ "Normal patellar anatomy beyond references needed to locate the injury", "Isolated patellar or quadriceps tendon rupture without patellar fracture", "Patellar dislocation or instability without an associated fracture", "Fractures confined to the distal femur or proximal tibia", "General osteoporosis, systemic disease and whole-person trauma management", "Detailed surgical techniques, implant specifications and medication prescribing" ], "distinguishing_features": [ "Require evidence locating a fracture in the patella itself; anterior knee pain and swelling alone do not establish the diagnosis. [AAOS](https://www.orthoinfo.org/diseases--conditions/patellar-kneecap-fractures/)", "Distinguish an acute fracture from a pre-existing bipartite patella using imaging interpretation and clinical history. [AAOS](https://www.orthoinfo.org/diseases--conditions/patellar-kneecap-fractures/)", "Determine whether an extension deficit accompanies a patellar bone injury or belongs to an isolated tendon injury.", "Record patellar displacement from the femoral groove separately from displacement between fracture fragments.", "Attribute an osteochondral fragment to its documented anatomical origin before classifying it as part of this fracture." ], "characteristics": [ { "name": "Affected patella", "kind": "relation", "unit_or_values": "Person, left or right patella, injury episode", "why_it_matters": "Keeps bilateral injuries and recurrent fractures distinguishable." }, { "name": "Diagnostic certainty", "kind": "state", "unit_or_values": "Suspected, confirmed, excluded, unresolved; dated supporting evidence", "why_it_matters": "Prevents an unverified injury label from becoming a confirmed fracture." }, { "name": "Injury context", "kind": "category", "unit_or_values": "Reported mechanism, onset date, skeletal maturity and native or resurfaced patella; unknown permitted", "why_it_matters": "Identifies which evidence and management pathway require review." }, { "name": "Fracture morphology", "kind": "category", "unit_or_values": "Superior pole, body or inferior pole; transverse, vertical, comminuted or other documented pattern", "why_it_matters": "Describes the actual injury beyond the generic fracture label." }, { "name": "Interfragmentary gap", "kind": "measurement", "unit_or_values": "Millimetres, with image plane, measurement site and date", "why_it_matters": "Supports comparison of fragment separation across examinations." }, { "name": "Articular step-off", "kind": "measurement", "unit_or_values": "Millimetres, with imaging method and uncertainty; not assessable permitted", "why_it_matters": "Records joint-surface incongruity separately from fragment separation." }, { "name": "Active knee extension", "kind": "state", "unit_or_values": "Preserved, impaired, absent or unassessable; straight-leg-raise result and examination limitations", "why_it_matters": "Makes functional assessment explicit rather than inferring it from fracture appearance." }, { "name": "Wound communication", "kind": "state", "unit_or_values": "Open, closed or uncertain; wound description and assessor", "why_it_matters": "Separates a superficial wound from documented communication with the fracture." }, { "name": "Protection prescription", "kind": "relation", "unit_or_values": "Treating clinician's brace, loading and knee-motion orders with effective dates", "why_it_matters": "Anchors activity support to the current individual plan." }, { "name": "Healing assessment", "kind": "state", "unit_or_values": "Clinician-assessed progression, union, delayed union, nonunion or uncertain", "why_it_matters": "Keeps biological healing distinct from elapsed time and functional recovery." }, { "name": "Knee movement and extension lag", "kind": "measurement", "unit_or_values": "Degrees of active and passive flexion and extension, with examination method", "why_it_matters": "Allows recovery and persistent deficits to be compared over time." } ], "affordances": [ "Assemble a fracture-specific evidence summary for clinical review.", "Identify missing assessments of fragment alignment, joint surface, extension function or wound status.", "Flag documented urgent findings for the responsible clinical team.", "Compare serial measurements and surface possible loss of alignment or stalled recovery.", "Represent clinician-authorised protection and rehabilitation instructions as dated constraints.", "Track unresolved symptoms and complications without equating bone union with full recovery." ], "agent_conduct": { "may": [ "Explain what a patella fracture is and its general treatment options.", "Urge a person with a suspected knee fracture to seek medical care." ], "must_not": [ "Diagnose a fracture or say whether it needs surgery.", "Advise putting weight on or exercising an injured knee in place of clinical advice.", "Share a patient's imaging or records without consent." ], "requires_human": [ "Any decision about surgery, immobilization or rehabilitation." ] }, "ethics": { "considerations": [ "Poor treatment of a kneecap fracture can cause lasting loss of mobility.", "Medical records are private health information." ], "affected_parties": [ "Patients", "Older people at fall risk", "Clinicians" ] }, "owners": { "steward": "Nobody owns the injury; the treating clinician answers for each patient.", "master_systems": [] }, "what_it_is_for": [ "A patella fracture is encountered in trauma assessment after injuries such as a fall onto the knee or a direct impact.", "Its location, displacement and effect on knee extension are documented to support clinician-directed treatment and rehabilitation." ], "standards_and_regulation": [ "The World Health Organization classifies fracture of the patella under code S82.0 in ICD-10." ], "visual_identification": [ "Knee imaging may show a fracture line interrupting the normally continuous outline or internal bone pattern of the patella.", "Imaging may show separated patellar fragments or a step in the joint surface, although some fractures remain aligned.", "Swelling and bruising over the kneecap can accompany a fracture but cannot distinguish it reliably from other knee injuries." ], "failure_modes_and_hazards": [ "Disruption of the knee extensor mechanism can impair active knee straightening and safe mobility.", "Damage to the joint surface can contribute to persistent pain, stiffness and post-traumatic arthritis.", "An open fracture can involve wound contamination and infection.", "Delayed union, nonunion or healing in poor alignment can prolong disability." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q1680525: patella fracture", "url": "https://www.wikidata.org/wiki/Q1680525", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Patella fracture", "url": "https://en.wikipedia.org/wiki/Patella_fracture", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "fracture-identity", "name": "Fracture identity", "description": "Establish which patella is injured and what evidence supports the diagnosis.", "rationale": "Patellar pain, extension difficulty and apparent fragmentation require anatomical and diagnostic discrimination.", "layers": [ { "id": "episode-and-mechanism", "name": "Episode and mechanism", "description": "Anchor the fracture to a side, onset and documented injury context.", "findings": [ { "id": "patellar-injury-episode", "name": "Patellar injury episode", "description": "Record the affected patella and distinguish reported mechanism from clinician interpretation.", "questions": [ { "text": "Which patella is affected, when did symptoms begin, and is this a new injury or reassessment of an existing fracture?", "kind": "definition", "id": "patellar-injury-episode-q01" }, { "text": "Who reported the mechanism, and what evidence supports an acute impact, traction event or another cause?", "kind": "provenance", "id": "patellar-injury-episode-q02" } ] } ] }, { "id": "confirmation-and-mimics", "name": "Confirmation and mimics", "description": "Connect diagnostic status to imaging and competing explanations.", "findings": [ { "id": "patellar-fracture-evidence", "name": "Patellar fracture evidence", "description": "Retain the interpreting clinician's conclusion and any unresolved distinction from a developmental variant or neighbouring injury.", "questions": [ { "text": "Which examination and imaging findings establish disruption of the patella, and who interpreted them?", "kind": "provenance", "id": "patellar-fracture-evidence-q01" }, { "text": "How were bipartite patella, isolated tendon rupture and patellar dislocation considered or excluded?", "kind": "boundary", "id": "patellar-fracture-evidence-q02" } ] } ] } ] }, { "id": "fragment-and-joint-geometry", "name": "Fragment and joint geometry", "description": "Describe the fracture configuration and its relationship to the patellofemoral surface.", "rationale": "A fracture label alone cannot communicate fragment separation, pole involvement or joint-surface alignment.", "layers": [ { "id": "fracture-configuration", "name": "Fracture configuration", "description": "Identify affected regions and the arrangement of fragments.", "findings": [ { "id": "location-and-fragmentation", "name": "Location and fragmentation", "description": "Record location, orientation and fragmentation without forcing an uncertain pattern into a single category.", "questions": [ { "text": "Does the fracture involve the superior pole, body, inferior pole or multiple regions, and what is its orientation?", "kind": "definition", "id": "location-and-fragmentation-q01" }, { "text": "How many fragments are identifiable, and what uncertainty remains about small, overlapping or osteochondral fragments?", "kind": "measurement", "id": "location-and-fragmentation-q02" } ] } ] }, { "id": "alignment-and-congruity", "name": "Alignment and congruity", "description": "Measure fragment separation and articular alignment independently.", "findings": [ { "id": "gap-and-step-off", "name": "Gap and step-off", "description": "Store reproducible measurements and their limitations rather than substituting an unexplained displaced or nondisplaced label.", "questions": [ { "text": "What are the measured interfragmentary gap and articular step-off, on which images and at which locations?", "kind": "measurement", "id": "gap-and-step-off-q01" }, { "text": "Are serial images sufficiently comparable to establish a change in alignment, or is further imaging interpretation needed?", "kind": "action", "id": "gap-and-step-off-q02" } ] } ] } ] }, { "id": "extension-and-soft-tissue-status", "name": "Extension and soft-tissue status", "description": "Assess functional continuity across the injured patella and the surrounding wound environment.", "rationale": "Extension function and wound communication express clinically important dimensions that fragment geometry does not capture.", "layers": [ { "id": "extensor-function", "name": "Extensor function", "description": "Separate observed performance from conclusions about structural continuity.", "findings": [ { "id": "active-extension-assessment", "name": "Active extension assessment", "description": "Patellar fracture can compromise knee extension; record the actual functional examination. [Cleveland Clinic](https://my.clevelandclinic.org/health/diseases/22081-patella-fracture)", "questions": [ { "text": "Can the person actively extend the knee and maintain a straight-leg raise, and how did pain or examination conditions limit assessment?", "kind": "measurement", "id": "active-extension-assessment-q01" }, { "text": "What evidence supports associated retinacular, quadriceps tendon or patellar tendon disruption?", "kind": "provenance", "id": "active-extension-assessment-q02" } ] } ] }, { "id": "wound-and-urgent-review", "name": "Wound and urgent review", "description": "Record skin injury, suspected communication and the clinical response.", "findings": [ { "id": "open-fracture-status", "name": "Open fracture status", "description": "Open patellar fractures require urgent treatment because of infection risk. [AAOS](https://www.orthoinfo.org/diseases--conditions/patellar-kneecap-fractures/)", "questions": [ { "text": "Is wound communication with the fracture confirmed, excluded or uncertain, and who assessed it?", "kind": "boundary", "id": "open-fracture-status-q01" }, { "text": "What urgent clinical review was requested for the documented wound or associated limb findings, and has responsibility been accepted?", "kind": "action", "id": "open-fracture-status-q02" } ] } ] } ] }, { "id": "treatment-and-protection", "name": "Treatment and protection", "description": "Represent the chosen treatment and its implications for loading and knee movement.", "rationale": "The agent needs the clinician's reasoning and current restrictions to support this injury episode coherently.", "layers": [ { "id": "treatment-selection", "name": "Treatment selection", "description": "Link the management decision to fracture evidence and patient circumstances.", "findings": [ { "id": "management-rationale", "name": "Management rationale", "description": "Record the clinician-selected operative or nonoperative pathway, alternatives considered and unresolved decision factors.", "questions": [ { "text": "How did alignment, extension function, wound status and individual circumstances inform the selected treatment?", "kind": "action", "id": "management-rationale-q01" }, { "text": "If surgery occurred, what fixation, fragment removal or tendon repair was documented, and where is the operative record?", "kind": "provenance", "id": "management-rationale-q02" } ] } ] }, { "id": "loading-and-motion-orders", "name": "Loading and motion orders", "description": "Make current protection requirements explicit and traceable.", "findings": [ { "id": "authorised-knee-use", "name": "Authorised knee use", "description": "Loading and movement restrictions should reflect the treating clinician's individual instructions. [AAOS](https://www.orthoinfo.org/diseases--conditions/patellar-kneecap-fractures/)", "questions": [ { "text": "What weight-bearing allowance, brace position and permitted knee-motion range are currently prescribed?", "kind": "action", "id": "authorised-knee-use-q01" }, { "text": "Who may change these restrictions, and which clinical or imaging review must precede progression?", "kind": "action", "id": "authorised-knee-use-q02" } ] } ] } ] }, { "id": "healing-and-functional-outcome", "name": "Healing and functional outcome", "description": "Follow structural healing, knee performance and persistent consequences.", "rationale": "Completing fracture care requires evidence of recovery across bone, extension function and meaningful activities.", "layers": [ { "id": "union-and-maintained-alignment", "name": "Union and maintained alignment", "description": "Track the clinician's healing assessment against serial evidence.", "findings": [ { "id": "fracture-healing-trajectory", "name": "Fracture healing trajectory", "description": "Keep imaging observations, symptoms and the clinical conclusion distinguishable at each follow-up.", "questions": [ { "text": "What serial evidence supports progressive union and maintained fragment alignment?", "kind": "measurement", "id": "fracture-healing-trajectory-q01" }, { "text": "What findings prompted review for delayed healing, loss of reduction, infection or fixation problems?", "kind": "action", "id": "fracture-healing-trajectory-q02" } ] } ] }, { "id": "knee-performance-and-sequelae", "name": "Knee performance and sequelae", "description": "Evaluate function and symptoms beyond the fracture's radiographic appearance.", "findings": [ { "id": "functional-recovery", "name": "Functional recovery", "description": "Persistent pain, stiffness and weakness can accompany recovery; track these separately from union. [Cleveland Clinic](https://my.clevelandclinic.org/health/diseases/22081-patella-fracture)", "questions": [ { "text": "How have extension lag, flexion range, quadriceps performance and personally relevant tasks changed from baseline?", "kind": "measurement", "id": "functional-recovery-q01" }, { "text": "What assessment supports attributing persistent symptoms to the fracture, joint injury, implants or another condition?", "kind": "boundary", "id": "functional-recovery-q02" }, { "text": "Which functional criteria and clinician authorisation support return to work, sport or unrestricted activity?", "kind": "action", "id": "functional-recovery-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": [ "This is recalled knowledge without source consultation; coding details should be checked against the applicable edition and jurisdiction.", "The listed kinds overlap: orientation, fragmentation, anatomical location, and tissue involvement are separate classification dimensions.", "The supplied ACT.ACT domain should be reviewed because patella fracture denotes an injury or condition." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of patella 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": [ "Transverse fracture", "Vertical or longitudinal fracture", "Comminuted fracture", "Superior or inferior pole fracture", "Osteochondral fracture", "Patellar sleeve fracture, typically occurring in children" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of patella 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", "value_or_pattern": "S82.0", "note": "WHO category for fracture of patella; national clinical modifications may require additional characters." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of patella 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": [ "Assessment of knee injuries after a fall, direct impact, or forceful quadriceps contraction", "Classification by fracture pattern, displacement, open or closed injury, and extensor mechanism integrity", "Planning immobilisation or operative repair", "Monitoring fracture healing, knee movement, and recovery of active extension" ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of patella fracture this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-measurements", "name": "Typical measurements", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "quantity": "Separation between fracture fragments", "typical_range": "Injury-dependent; no single typical range", "unit": "mm" }, { "quantity": "Articular surface step-off", "typical_range": "Injury-dependent; no single typical range", "unit": "mm" }, { "quantity": "Knee range of motion and extensor lag", "typical_range": "Depends on injury severity and stage of recovery", "unit": "degrees" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of patella 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": [ "Disruption of the extensor mechanism with loss of active knee extension", "Post-traumatic patellofemoral arthritis and persistent anterior knee pain", "Knee stiffness or persistent extensor lag", "Delayed union, nonunion, or malunion", "Infection in open fractures or after surgery" ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of patella 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": [ "Diagnostic coding detail varies between WHO ICD-10 and national clinical modifications." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of patella 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": "Bipartite patella", "difference": "A developmental separation of ossification centres, generally with corticated margins, rather than an acquired fracture." }, { "name": "Patellar dislocation", "difference": "The patella loses its normal alignment with the femoral trochlea; a fracture may coexist but is not required." }, { "name": "Patellar tendon rupture", "difference": "The tendon connecting the patella to the tibial tubercle is torn rather than the patellar bone being fractured." }, { "name": "Quadriceps tendon rupture", "difference": "The tendon above the patella is torn; it can impair active extension without a patella fracture." }, { "name": "Patellar stress fracture", "difference": "A subtype caused by repetitive loading rather than a single acute traumatic event." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of patella fracture this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Which displacement and articular step-off thresholds are supported for particular fracture patterns and patient populations, and how should conflicting recommendations be represented?", "What additional evidence and assessment layers are needed for paediatric sleeve injuries, stress fractures and fractures of a resurfaced patella within this single registry entry?", "Which imaging strategy best resolves suspected fracture or osteochondral injury when initial radiographs are inconclusive?", "Which loading and knee-motion progression criteria are supported for each treatment approach, and how much variation reflects evidence versus local practice?", "Which validated functional measures and follow-up intervals best distinguish radiographic union from durable recovery after patellar fracture?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 18, "questions": 29 } }