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Pag-aayos ng Distal Triceps

PDF Evidence Consent
Updated Sep 2026
Illustration: Pag-aayos ng Distal Triceps

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Bakit iminungkahi ang operasyong ito

Si Dr Kieran Hirpara, isang upper-limb surgeon sa Mater Private Hospital Rockhampton, ay itinutugma ang gamutan sa iyong partikular na pinsala. Ang triceps ay ang tendon sa likod ng iyong siko na nagtutuwid ng iyong braso. Kapag ito ay ganap na napunit palayo sa buto, karaniwang kinakailangan ang operasyon upang maibalik ang paggalaw na iyon. Ang operasyong ito, na tinatawag na distal triceps repair, ay muling nagkakabit sa napunit na tendon.

Ang mga pasyente ay karaniwang nirerefer sa aming klinika ng kanilang GP; kung iminungkahi ng isang physiotherapist na magpatingin sa amin, kakailanganin mo pa rin ng referral mula sa iyong GP upang maging eligible para sa Medicare rebate. Sinusuri namin ang iyong history, sinusuri ang iyong siko, at nag-aayos ng imaging kung kinakailangan upang kumpirmahin ang diagnosis.

Para sa partial tear, maaaring subukan muna ang non-operative care gaya ng physiotherapy. Isinasagawa ang operasyon kapag hindi ito nagbigay ng sapat na pagbuti, o kapag ang punit ay kumpleto. Madalas itong inirerekomenda para sa mga aktibong tao, mga manggagawang gumagamit nang husto ng kanilang mga braso, at mga atleta na gustong bumalik sa kompetisyon. Layunin ng repair na maibalik ang lakas at function, kung saan karamihan sa mga tao ay nakakabalik sa trabaho sa loob ng humigit-kumulang 2.2 buwan at 89.3% ang bumabalik sa sports.

Bago ang operasyon

Kukumpirmahin ng iyong surgeon ang punit sa pamamagitan ng mga scan bago planuhin ang iyong repair. Karaniwan itong nagsisimula sa mga X-ray, na nagpapakita kung may maliit na piraso ng buto na nahila kasama ng tendon. Maaaring gumamit ng MRI scan upang masusing suriin ang mismong tendon.

Bago ang operasyon, kakailanganin mong itigil ang pagkain at pag-inom pitong oras bago ito. Humihingi kami ng pitong oras sa halip na anim upang maaaring mapabilis ang iyong operasyon kung maagang matapos ang theatre list. Sasabihin sa iyo ng iyong surgeon kung aling mga gamot ang dapat itigil at kailan. Magdala ng nakasulat na listahan ng lahat ng iyong iniinom. Mag-ayos ng taong maghahatid sa iyo pauwi pagkatapos, at magsuot ng maluwag at komportableng damit sa araw na iyon. Kung mayroon kang iba pang kondisyong medikal, maaaring kailanganin mo ng mga blood test o review kasama ang anaesthetist.

Sa araw ng operasyon

Darating ka sa surgical admissions unit ng ospital, kung saan ka ire-rehistro at ihahanda para sa theatre. Pagkatapos ay makikipagkita ka sa anaesthetist, ang doktor na magpapatulog sa iyo at mamamahala sa iyong sakit habang isinasagawa ang operasyon. Ang operasyong ito ay ginagawa sa ilalim ng general anaesthetic. Minsan ay nagdaragdag ng regional nerve block para sa pagpapaginhawa ng sakit pagkatapos ng operasyon; tatalakayin ito ng anaesthetist sa iyo sa araw na iyon. Pagkatapos ay dadalhin ka sa operating theatre, kung saan isasagawa ang repair.

Pagkatapos, magigising ka sa recovery area, kung saan babantayan kang mabuti ng mga nurse habang nawawala ang bisa ng anaesthetic. Kapag stable ka na, pupunta ka sa ward o uuwi na, depende sa procedure at kung paano ang iyong paggaling. Kung uuwi ka sa araw ring iyon, kakailanganin mo ang taong inayos mo na nang mas maaga upang magmaneho para sa iyo.

Ano ang kinapapalooban ng operasyon

Ang triceps tendon ay nakakabit sa isang maliit na bahagi ng buto sa dulo ng iyong siko. Sa isang complete tear, ang tendon ay humiwalay mula sa butong iyon, na katulad ng isang lubid na kumalas mula sa anchor point nito. Ang layunin ng operasyon ay itahi muli ang tendon pabalik sa buto kung saan ito dapat nakakabit.

Gagawa ang iyong surgeon ng hiwa sa likod ng iyong siko upang maabot ang napunit na tendon. Pagkatapos ay muling ikakabit ang tendon sa natural na attachment spot nito sa buto gamit ang maliliit na anchor na inilalagay sa loob ng buto, kasama ang matitibay na tahi na humahawak sa tendon nang may pantay na tensyon. Ibinabalik nito ang normal na hugis at posisyon ng attachment ng tendon, na nagbibigay ng lakas sa repair.

Ang ilang repair ay gumagamit ng teknik na tinatakpan ang buong attachment area ng dalawang hanay ng mga anchor, tulad ng pagtatahi ng laylayan gamit ang dalawang parallel na linya. Ang iba naman ay gumagamit ng mga anchor na gawa nang buo sa stitching material, na humahawak sa tendon nang kasing-tibay ng mga standard anchor. Pipiliin ng iyong surgeon ang metodong angkop sa iyong pinsala.

Kapag secure na ang tendon, susuriin ng surgeon kung maayos ang paggalaw ng repair, pagkatapos ay sasara ang hiwa gamit ang mga tahi at lalagyan ng dressing. Pananatilihin mo ang dressing na iyon sa loob ng humigit-kumulang 10 araw, gaya ng inilarawan sa recovery section.

Ang operasyon mismo ay simple ang konsepto: ibalik ang napunit na tendon sa buto at hawakan ito nang sapat na tibay upang ito ay gumaling. Ang mga susunod na mangyayari, at kung gaano kabilis mo maaaring igalaw at gamitin ang braso, ay nakasaad sa recovery section na kasunod nito.

Pagkatapos ng operasyon

Magigising ka sa recovery area, kung saan babantayan ka nang maigi ng mga nurse habang nawawala ang bisa ng anaesthetic. Ang iyong braso ay ilalagay sa isang simpleng sling para sa iyong komportable. Ang siko ay hindi naka-lock sa isang posisyon; ang banayad na paggalaw ay magsisimula nang maaga. Ang pagpapagaling sa sakit (pain relief) ay iaangkop para sa iyo, at pananatilihin ng mga nurse na komportable ka. Dapat may kasama ka sa unang 24 oras pagkatapos mong makauwi. Sasabihin sa iyo ng iyong team kung uuwi ka sa mismong araw o mananatili ng isang gabi sa ospital. Hahayaan naming nakalagay ang dressing sa loob ng humigit-kumulang 10 araw; pakiusap na huwag itong tanggalin bago ang panahong iyon maliban kung sinabi namin sa iyo. Papalitan o tatanggalin namin ito kapag nakita ka namin. Karamihan sa mga tao ay naglalakad at gumagalaw sa araw ng operasyon, nang dahan-dahan lamang.

Paggaling

Sa unang ilang araw, ang iyong siko ay magiging masakit at mamamaga. Unti-unti itong huhupa. Makakatulong ang pahinga, pagpapanatiling nakataas ng iyong kamay kapag nakaupo, at ang mga gamot sa sakit na inireseta para sa iyo. Ang iyong braso ay nakalagay sa isang simpleng sling para sa ginhawa, ngunit ang siko ay hindi naka-lock nang hindi gumagalaw, at ang banayad na paggalaw ay magsisimula nang maaga.

Ang hand therapy ay isang malaking bahagi ng iyong paggaling. Ang iyong mga session ay kasama si Ruby Doolan sa Extend Rehabilitation. Si Ruby ay isang hand therapist: ginagabayan niya ang iyong mga ehersisyo at gumagawa ng anumang splint na kailangan mo. Sa simula, ang pokus ay ang pagprotekta sa repair habang binabawi ng iyong siko ang paggalaw nito. Habang gumagaling ang tendon, ang mga ehersisyo ay unti-unting dadagdagan upang maibalik ang lakas para sa pagtuwid ng iyong braso laban sa resistance.

Sa araw-araw, mapapamahalaan mo ang mga magagaan na gawain sa bahay gamit ang iyong kabilang kamay habang humuhupa ang repair. Hindi ka magmamaneho habang ang iyong braso ay nasa sling, at kailangan mong maging kakayahang humawak sa manibela gamit ang dalawang kamay at makatugon sa isang emergency stop, nang walang iniinom na matapang na gamot sa sakit, bago ka muling magmaneho. Ang aming gabay sa driving after upper-limb surgery ay nagpapaliwanag nito nang mas detalyado.

Ang mga milestone ay dumarating bilang mga kaganapan sa halip na mga petsa. Kapag humupa na ang pamamaga, ang pagbaluktot at pagtuwid ay magiging mas madali. Kapag pinayagan na ng iyong therapist ang iyong strength work, magsisimula ka nang maglagay ng load sa braso. Karamihan sa mga tao ay bumabalik sa trabaho at sports sa parehong intensity na mayroon sila bago ang pinsala. Maaaring mag-iba ang iyong timeline; gagabayan ka ng iyong surgeon at ni Ruby.

Ano ang maaaring maging problema

Karamihan sa mga pasyente ay gumagaling nang maayos, ngunit paminsan-minsan ay maaaring magkaroon ng mga problema. Binabantayan kayo nang maigi ng inyong surgeon at ng team upang maagapan ang anumang isyu.

Ang pinakaseryosong problema ay ang muling pagkapunit ng repair. Maaari kayong makaramdam ng biglaang "pop" o pagbigay sa likod ng inyong siko, na susundan ng panghihina kapag sinusubukan ninyong ituwid ang inyong braso laban sa isang bagay. Ang ilang tao ay nakapapansin ng pamamaga at pasa sa dulo ng siko, katulad ng naramdaman noong unang pumunit ang tendon. Kung mangyari ito, makipag-ugnayan agad sa klinika. Susuriin ng inyong surgeon ang siko at mag-aayos ng mga scan upang tingnan kung nanatiling buo ang repair.

Ang ilang problema ay lumalabas sa paligid mismo ng sugat. Bantayan ang sakit na patuloy na lumalala sa halip na humuhupa, pamumula na kumakalat mula sa sugat, o likidong tumatagas sa dressing. Mahalaga rin ang lagnat o pangkalahatang pakiramdam na hindi mabuti kasabay ng mga palatandaang ito. Kung mapansin ninyo ang alinman sa mga ito, tawagan ang klinika sa mismong araw na iyon sa halip na maghintay para sa inyong susunod na bisita.

Paminsan-minsan, ang isang repair ay nangangailangan ng karagdagang operasyon. Maaaring dahil ito sa muling pagkapunit ng tendon, o dahil may ibang bagay sa repair na hindi gumagaling sa paraang nararapat. Karaniwan ninyo itong malalaman sa pamamagitan ng patuloy na sakit, panghihina, o pakiramdam na ang siko ay hindi bumabawi gaya ng inaasahan. Banggitin ito sa inyong review appointment, o makipag-ugnayan sa amin nang mas maaga kung malinaw na may mali.

Ang paggaling mula sa mga problemang ito ay maaaring tumagal nang higit pa sa orihinal na plano, at ang ilang tao ay nangangailangan ng mas mahabang panahon ng pagliban sa trabaho o normal na aktibidad kaysa sa kanilang unang inaasahan. Ipapaliwanag sa inyo ng inyong surgeon ang nangyari at kung ano ang mga susunod na hakbang kung maapektuhan kayo nito.

Ang table ng mga komplikasyon sa pahinang ito ay naglilista ng mga tipikal na rate kung nais ninyo ang mga detalye.

Kailan dapat tumawag sa amin

Karamihan sa mga paggaling ay nagiging maayos, ngunit may ilang mga palatandaan na nangangailangan ng mabilis na atensyon. Tumawag sa amin kung kayo ay may lagnat, o kung ang pamumula o paglabas ng likido (discharge) sa paligid ng sugat ay patuloy na nadaragdagan. Kung nakaramdam kayo ng biglaang "pop" na may kasamang panghihina kapag itinuwid ang inyong braso, tumawag agad sa amin, o pumunta sa emergency department kung lampas na sa oras ng opisina. Pumunta sa emergency kung kayo ay may biglaang matinding sakit sa siko na hindi humuhupa sa inyong pain relief. Pumunta sa emergency kung ang inyong binti (calf) ay namamagâ o sumasakit, o kung kayo ay nahihirapang huminga. Pumunta sa emergency kung mawalan kayo ng pakiramdam sa inyong braso o kamay, o kung hindi ninyo maigalaw ang bahagi ng katawan.

Reviewed by AI synthesis (v2) — pending human review · 21 August 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Anatomy & Pathophysiology

Bony Anatomy

  • The elbow is a trocho-ginglymoid joint consisting of medial and lateral articulations that provide bony stability [3].
  • The trochlea articulates with the ulna within the greater sigmoid notch to form the ulnohumeral, hinged, or trochoid portion of the elbow joint [3].
  • The ulnohumeral articulation provides highly congruent anatomy through almost 180° of articular contact [3].
  • The greater sigmoid notch of the ulna contains a bare area devoid of cartilage [3].
  • The coronoid process has medial and lateral facets that buttress the trochlea anteriorly [3].
  • The sublime tubercle is located just distal and medial to the coronoid and serves as the attachment site for the anterior bundle of the medial ulnar collateral ligament [3].
  • The medial epicondyle is larger and more posteriorly oriented than the lateral epicondyle [3].
  • The capitellum and radial head form the radiocapitellar joint [3].
  • The radius is held in close approximation to the ulna at the proximal radioulnar joint by the annular ligament [3].
  • The lesser sigmoid notch is the area of the ulna that articulates with the margin of the radial head at the proximal radioulnar joint [3].
  • The radial head is a concave elliptical structure covered with articular cartilage along the radiocapitellar joint and approximately 270° of the articular margin [3].
  • The lateral epicondyle is the origin of the lateral extensor musculature [3].
  • The origin of the lateral ulnar collateral ligament complex is located just distal to the lateral epicondyle at the geometric center of the radiocapitellar articulation [3].
  • The distal humeral articulation is angled 30° from the longitudinal axis [3].
  • The anterior humeral line should pass through the center of the axis of rotation [3].
  • The axis of rotation is angulated 5° to 7° in the coronal plane relative to the epicondylar axis, with the medial side more distal than the lateral side [3].
  • The olecranon provides a broad attachment site for the triceps [3].
  • The ulna bends approximately 8° medially at 8 cm from the tip of the olecranon [3].
  • The articulation to the tip of the coronoid is approximately 30° from the long axis of the ulna in the sagittal plane [3].

Ligaments and Soft Tissue

  • The medial ulnar collateral ligament is comprised of the anterior bundle, posterior bundle, and transverse ligament [2].
  • The anterior bundle of the medial ulnar collateral ligament is the strongest component and the primary restraint to valgus stress [2].
  • The anterior bundle of the medial ulnar collateral ligament is subdivided into anterior and posterior bands that provide reciprocal function, with the anterior band tight in extension and the posterior band tight in flexion [2].
  • The lateral ulnar collateral ligament origin center is 10.7 mm from the lateral epicondyle [2].
  • The lateral ulnar collateral ligament insertion is 3.3 mm from the apex of the supinator crest [2].
  • The triceps muscle insertions have three distinct insertional areas to the olecranon: posterior capsular insertion, deep muscular portion, and superficial tendinous portion [2].
  • The deep muscular head of the triceps corresponds to the medial head of the triceps [2].
  • The superficial tendinous portion of the triceps corresponds to the long and lateral heads [2].
  • The width of the triceps insertion is 2.6 cm [2].
  • The triceps insertion is located 1.1 cm from the tip of the olecranon [2].
  • The primary elbow extensor, the triceps, inserts on the olecranon process [4].
  • The brachialis is the strongest elbow flexor and attaches to the coronoid 11 mm distal to the tip [4].
  • The biceps brachii inserts at the ulnar margin of the radial tuberosity, with the long head inserting proximally and the short head distally [4].
  • The biceps brachii is a powerful supinator of the forearm [4].
  • The mobile wad consists of the brachioradialis, extensor carpi radialis longus, and extensor carpi radialis brevis [4].
  • The flexor-pronator mass consists of the pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, and flexor digitorum superficialis [4].
  • Tensile forces are present at the medial elbow while compressive forces are present at the lateral elbow [4].
  • The elbow capsule allows maximum distension at approximately 70 to 80 degrees of flexion [4].
  • The anterior capsule attaches at a point approximately 6 mm distal to the tip of the coronoid [4].
  • The coronoid tip is an intraarticular structure visualized during elbow arthroscopy [4].
  • The medial or ulnar collateral ligament is the primary valgus stabilizer [4].
  • The anterior bundle of the medial ulnar collateral ligament is the most important component for stability [4].
  • The posterior bundle of the medial ulnar collateral ligament has the greatest change in length and becomes taut at flexion beyond 120 degrees [4].
  • The lateral ulnar collateral ligament is the posterolateral stabilizer [4].
  • Osborne’s ligament stabilizes the ulnar nerve in the cubital tunnel [4].
  • The ligament of Struthers is a variant anatomy arising from the supracondylar process to attach to the medial epicondyle and is a potential site of median nerve compression [4].

Biomechanics and Motion

  • The normal elbow has a range of motion from 0° to 140° from extension to flexion [1].
  • The normal elbow has a range of motion of 75° in pronation and 85° in supination [1].
  • A functional arc for flexion and extension is 100° [1].
  • A functional arc for forearm rotation is 100° [1].
  • Elbow stability is determined by primary and secondary stabilizers [1].
  • The three primary stabilizers of the elbow are the ulnohumeral articulation, the medial ulnar collateral ligament, and the lateral ulnar collateral ligament complex [1].
  • Secondary stabilizers of the elbow include the radiocapitellar articulation, the common flexor tendon, the common extensor tendon, and the joint capsule [1].

Investigations

Physical Examination

  • The physical examination of the elbow is directed by the history and the location of the patient's pain in the anterior, posterior, medial, or lateral aspect [1].
  • Active and passive flexion, extension, supination, and pronation should be evaluated using a goniometer for accurate measurement [9].
  • The contralateral elbow should be examined for comparison during range of motion assessment [9].
  • If the elbow has less than 90° to 100° of flexion, the posterior bundle of the medial collateral ligament is contracted and must be released to restore flexion [9].
  • Pain during the mid-arc of motion is more common with intrinsic disease and may not improve with contracture release alone [9].
  • The ulnar nerve is of utmost importance in the physical examination due to its anatomic proximity to the elbow [9].
  • The posterior bundle of the medial collateral ligament forms the floor of the cubital tunnel along the course of the ulnar nerve [9].
  • Electromyography and nerve conduction velocity studies should be performed if there is any question about neurologic dysfunction [9].
  • An assessment for ulnar nerve subluxation should be performed, as subluxation is a relative contraindication for an arthroscopic procedure secondary to possible iatrogenic nerve injury [9].
  • The soft tissue surrounding the elbow should be examined for previous skin incisions, grafts, eschar, or infection [9].

Imaging

  • Plain radiographs remain the hallmark and the best screening test for elbow evaluation [1].
  • Standard radiographic views include AP, lateral, and oblique views [9].
  • Serial radiography is used as follow-up when heterotopic ossification is present [9].
  • Primary bony landmarks assessed on radiographs include the ulnohumeral joint, coronoid process, radial head, capitellum, radiocapitellar joint, olecranon tip, coronoid/olecranon fossae, and trochlear ridge [9].
  • CT is helpful when assessing for malunion architecture and the location and pattern of osteophytes and/or loose bodies [9].
  • Three-dimensional CT is used to check for heterotopic ossification [9].
  • CT is not necessary when the stiffness is entirely soft-tissue related [9].
  • CT is beneficial if any joint incongruity or abnormal bony anatomy is present [9].
  • MRI can be used to evaluate ligaments and tendons, but it is rarely indicated for elbow stiffness [9].
  • AP, lateral, oblique, and axillary views of the elbow may reveal posteromedial olecranon osteophytes and/or loose bodies in valgus extension overload syndrome [11].
  • CT with two-dimensional reconstruction and three-dimensional surface rendering best visualizes the pathology of valgus extension overload syndrome [11].
  • MRI may be most helpful in evaluating associated injuries including partial or complete tears of the medial collateral ligament in valgus extension overload syndrome [11].
  • Radiographic evaluations are essential when diagnosing an osteochondritis dissecans lesion of the elbow [12].
  • Important aspects of osteochondritis dissecans lesions may be better seen with MRI [12].

References

[1] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Biomechanics, Physical Examination, and Imaging of the Elbow > Summary and Conclusions.

[2] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Biomechanics, Physical Examination, and Imaging of the Elbow > Annotated References.

[3] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Biomechanics, Physical Examination, and Imaging of the Elbow > Anatomy > Bony Anatomy.

[4] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > TABLE 2.3 Shoulder Spaces.

[9] Aaos Comprehensive Orthopaedic Review 3. Elbow Stiffness* > IV. Evaluation.

[11] Aaos Comprehensive Orthopaedic Review 3. Elbow Injuries in the Athlete* > III. Valgus Extension Overload Syndrome and Posterior Impingement.

[12] Orthopaedic Knowledge Update. Osteochondritis Dissecans of the Knee and Elbow* > Summary.

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a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.