Skip to content

Patients › Elbow

Olecranon Fracture Fixation (ORIF)

PDF Evidence Consent
Updated Sep 2026
Illustration: Olecranon Fracture Fixation (ORIF)

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 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. Sa iyong appointment, kumukuha kami ng history, sinusuri ang iyong siko at nagsasaayos ng imaging kung kinakailangan. Sinasabi nito sa amin kung ang nabaling buto sa dulo ng iyong siko ay naalis sa puwesto.

Kung ang mga piraso ay halos hindi gumalaw, ang bali ay madalas na maaaring mapamahalaan nang walang operasyon, gamit ang isang splint at mga check X-ray upang matiyak na walang gumagalaw. Ito ang karaniwang unang opsyon na aming tinatalakay. Iminumungkahi ang operasyon kapag ang bali ay sapat na gumalaw na hindi ito gagaling sa isang kapaki-pakinabang na posisyon nang kusa. Ang layunin ng operasyon ay panatilihin ang mga piraso sa kanilang normal na posisyon habang sila ay nagdurugtong, upang manatiling makinis ang ibabaw ng siko. Ang magaspang na ibabaw ay maaaring humantong sa wear-and-tear arthritis sa joint sa paglipas ng panahon. Ang pagpapanatili sa buto nang secure ay nagbibigay-daan din sa iyo na simulan ang paggalaw ng siko nang maaga, na nagpapababa ng pagkakataon ng permanenteng paninigas. Karamihan sa mga taong sumasailalim sa operasyong ito ay pinananatili ang kanilang mga implant, at 3% lamang ang nakakaranas ng paggalaw ng implant pagkatapos.

Bago ang operasyon

Kapag naplano na ang operasyon, bibigyan ka namin ng malinaw na mga tagubilin na dapat sundin. Kakailanganin mong itigil ang pagkain at pag-inom pitong oras bago ang operasyon. Humihingi kami ng pitong oras sa halip na ang karaniwang anim upang maaaring ilipat nang mas maaga ang iyong oras kung maagang matapos ang listahan sa theatre. Ang ilang mga gamot ay maaaring makaapekto sa operasyon, kaya magdala ng nakasulat na listahan ng lahat ng iyong iniinom at sasabihin namin sa iyo kung alin ang mga dapat itigil muna. Mag-ayos ng taong maghahatid sa iyo pauwi pagkatapos. Magsuot ng maluwag at komportableng damit na may mga manggas na madaling maiaurong sa iyong siko. Ang imaging gaya ng X-ray, MRI o ultrasound ay maaaring i-schedule bago ang operasyon upang maplano ito. Kung mayroon kang iba pang kondisyong medikal, maaaring kailanganin mo ng mga blood test o pagsusuri kasama ang anaesthetist, ngunit karamihan sa mga tao ay hindi.

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 mamamahala sa iyong anaesthetic at pain relief. Ang operasyong ito ay ginagawa sa ilalim ng general anaesthetic. Minsan ay nagdaragdag ng regional nerve block para sa post-operative pain relief; tatalakayin ito ng anaesthetist sa iyo sa araw na iyon. Pagkatapos ay dadalhin ka sa operating theatre, kung saan isasagawa ang operasyon. Pagkatapos nito, magigising ka sa recovery area, kung saan babantayan ka ng mga nurse habang nawawala ang bisa ng anaesthetic. Kapag stable ka na, ililipat ka sa ward o uuwi na, depende sa procedure at kung paano ang iyong paggaling.

Ano ang kinapapalooban ng operasyon

Ang operasyon ay tinatawag na open reduction and internal fixation. Ang "open" ay nangangahulugang naaabot ng siruhano ang bali sa pamamagitan ng isang hiwa sa likod ng iyong siko, sa ibabaw mismo ng dulo ng siko. Ang "reduction" ay nangangahulugang ang mga nabaling piraso ay ibinabalik sa kanilang normal na posisyon, at ang "internal fixation" ay nangangahulugang pinapanatili sila roon gamit ang mga metal implant habang naghihilom ang buto.

Pinipili ng siruhano ang implant na angkop sa iyong bali, dahil walang iisang teknik na angkop sa lahat ng uri ng bali. Para sa simpleng bali na nahati sa dalawang piraso, ang mga piraso ay maaaring hawakan ng isang wire loop na nagdidikit sa mga ito habang ikaw ay gumagalaw, o sa pamamagitan ng isang screw na inilalagay sa gitna ng buto. Para sa mga baling nahati sa ilang piraso, o sa mas malambot na buto, madalas na ginagamit ang isang plate na hinuhubog sa likod ng siko at hinahawakan ng maliliit na screw. Ang ilang bali ay maaaring hawakan ng matitibay na tahi na naka-angkla sa buto sa halip na metal. Anuman ang metodong gamitin, iisa ang layunin: isang matatag na pagkakakapit na magbibigay-daan sa iyo na simulan ang paggalaw ng siko nang maaga.

Kapag ang mga piraso ay nasa kanilang normal na posisyon na at secure na ang implant, sinusuri ng siruhano kung makinis ang ibabaw ng siko at kung malayang nakakagalaw ang joint. Ang mga layer ng tissue ay tinatahi muli at ang balat ay isinasara gamit ang mga tahi, pagkatapos ay tatakpan ng dressing.

Pagkatapos ng operasyon

Pagkagising mo, ang iyong braso ay ilalagay sa isang simpleng sling para sa iyong ginhawa. Susuriin ka ng mga nurse at bibigyan ka ng gamot sa sakit kung kinakailangan. Dapat may kasama ka sa unang 24 oras pagkatapos mong umuwi. Sasabihin sa iyo ng iyong team kung uuwi ka sa araw ding iyon o mananatili ng isang gabi sa ospital. Maaari ka nang gumalaw sa oras na maramdaman mong matatag ka na, at tinatanggal ang sling para sa paghuhugas at para sa mga ehersisyo na ituturo sa iyo ng iyong team. Hinahayaan naming nakakabit 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. Panatilihing gumagalaw ang iyong kamay at mga daliri mula sa unang araw, dahil nakakatulong ito sa pamamaga at ginhawa.

Paggaling

Sa unang ilang araw, ang iyong siko ay magiging masakit at namamagà, at ang balat sa paligid nito ay maaaring magmukhang may pasa. Unti-unti itong huhupa. Nakatutulong ang pagpapanatiling gumagalaw ng iyong kamay at mga daliri mula sa unang araw, gayundin ang pagpapatong ng iyong braso sa mga unan kapag ikaw ay nakaupo o natutulog. Inumin nang regular ang ibinigay na gamot sa sakit sa simula pa lamang sa halip na hintayin pang tumindi ang sakit.

Ang iyong braso ay nakalagay sa isang simpleng sling para sa ginhawa sa mga unang araw. Tinatanggal ito para sa paghuhugas at para sa iyong mga ehersisyo. Ang hand therapy pagkatapos ng operasyon ay kasama si Ruby Doolan sa Extend Rehabilitation. Ipapakita sa iyo ni Ruby ang mga ehersisyo na nagpapanatiling gumagalaw ng iyong siko habang naghihilom ang buto, at gagawa siya ng splint kung kakailanganin mo nito. Pananatilihin mong gumagalaw ang iyong mga daliri at kamay mula sa simula, at idaragdag ang banayad na paggalaw ng siko habang humuhupa ang bali. Ang mga pang-araw-araw na gawain ay nangangailangan ng ilang pagpaplano sa simula: kakailanganin mo ng tulong sa mga pagkain, pagbibihis, at pagdadala ng mga bagay hanggang sa maging matatag muli ang iyong braso.

Habang humuhupa ang pamamaga at bumabalik ang paggalaw, mapapansin mong nagiging mas madali ang mga ehersisyo. Kapag nasisiyahan na ang iyong surgeon na maayos ang paghihilom ng buto, tuluyan nang tatanggalin ang sling at magsisimula ka nang gamitin ang braso para sa mga magagaan na gawain sa loob ng bahay. Ang mas mabibigat na pagbubuhat, sports, at pagmamaneho ay susunod na, kapag sumang-ayon na ang iyong therapist at surgeon na sapat na ang lakas ng siko. Kung ang pagmamaneho ay nasa iyong listahan, tingnan ang aming gabay sa driving after upper-limb surgery para sa mga panuntunang naaangkop.

Ang bawat tao ay gumagaling sa magkakaibang bilis, kaya maaaring mag-iba ang iyong timeline. Gagabayan ka ng iyong surgeon at ng iyong hand therapist sa bawat pagbisita.

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 maagang matukoy ang anumang isyu.

Ang metal na humahawak sa buto ay maaaring gumalaw paminsan-minsan mula sa kinalalagyan nito. Maaari kayong makaramdam ng bagong matalas na sakit sa dulo ng inyong siko, isang bukol sa ilalim ng balat na wala noon, o ang balat ay nagiging sugat o gasgas kung saan nakalagay ang implant. Kung maramdaman ito, tumawag sa klinika sa halip na maghintay para sa inyong susunod na bisita.

Ang mga wire o implant ay maaari ring dumiin o tumagos sa balat. Nagdudulot ito ng sakit at iritasyon sa balat, at ang sugat ay maaaring bumuka sa bahaging iyon. Ipaalam agad sa amin kung makikita ito, dahil maaaring kailangang tanggalin ang implant.

Ang impeksyon ay isang panganib sa anumang operasyon. Bantayan ang malalim at tumitibok na sakit na hindi nawawala sa simpleng painkiller, pamumula na kumakalat mula sa sugat, pagtagas ng likido mula rito, o lagnat. Kung mapansin ang alinman sa mga ito, makipag-ugnayan sa klinika sa mismong araw na iyon o pumunta sa emergency department kung hindi niyo kami maabot.

Ang impeksyon ay maaari ring magpabagal sa pagdugtong ng buto. Kung ang paggaling ay tila mas matagal kaysa sa inaasahan ng inyong team, banggitin ito sa inyong susunod na review.

Ang nerve na dumadaan sa likod ng dulo ng inyong siko ay maaaring mairita. Maaari itong magdulot ng pangingilig, pakiramdam na parang tinutusok ng karayom (pins and needles), o pamamanhid pababa sa loob na bahagi ng inyong forearm at patungo sa inyong kalingkingan at ring finger. Banggitin ang alinman sa mga pakiramdam na ito sa inyong review, o tumawag sa klinika kung bigla itong lumitaw.

May ilang tao na nakapapansin ng bahagyang kawalan ng kakayahang maiunat nang husto ang siko, kahit na gumaling nang maayos ang bali. Ang iba naman ay nagkakaroon ng wear-and-tear arthritis sa joint sa paglipas ng panahon, na maaaring maramdaman bilang pagkirot, pag-click, o pag-grinding. Parehong mahalagang banggitin ang mga ito sa follow-up upang masubaybayan sila ng inyong team.

Ang buto ay maaari ring mabigong magdugtong, o magdugtong sa maling posisyon. Kung ang inyong siko ay nananatiling masakit at unstable pagkatapos ng ilang linggo ng paggaling, susuriin namin ito gamit ang X-ray.

Ang paninigarilyo ay nagpapataas ng pagkakataon ng mga problema pagkatapos ng operasyong ito. Kung kayo ay naninigarilyo, makipag-usap sa inyong GP tungkol sa paghinto bago ang operasyon.

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

Kailan dapat tumawag sa amin

Karamihan sa mga problema ay lumalabas nang maaga, at mas gusto naming malaman ang mga ito agad. Tumawag sa amin kung ikaw ay may lagnat, kung ang sugat ay lalong namumula o nagsisimulang maglabas ng likido, o kung ang sakit ay biglang lumala. Pumunta sa emergency kung ikaw ay may pamamaga sa iyong binti (calf), hinihingal, o may pananakit ng dibdib. Tumawag din sa amin kung ang iyong mga daliri o kamay ay namamanhid, malamig, o kung hindi mo maigalaw ang iyong braso. Kung hindi mo kami ma-contact at may nararamdamang urgent, pumunta sa pinakamalapit na emergency department.

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 medial epicondyle forms the attachment site for the origins of the flexor pronator mass [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 radial head articulates with both the capitellum and the lesser sigmoid notch [3].
  • The lateral epicondyle is the origin of the lateral extensor musculature [3].
  • The origin of the lateral ulnar collateral ligamentous 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].
  • There is a high correlation between the size of the radial head and capitellum on the left and right sides of the same individual [2, 3].

Ligaments and Soft Tissue

  • Elbow stability is determined by primary stabilizers, which include 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].
  • The medial ulnar collateral ligament is the primary valgus stabilizer of the elbow [4, 5].
  • The anterior bundle of the medial ulnar collateral ligament is the most important component for stability [4, 5].
  • The posterior bundle of the medial ulnar collateral ligament becomes taut at flexion beyond 120 degrees [4, 5].
  • The lateral ulnar collateral ligament acts as a posterolateral stabilizer [4, 5].
  • Osborne’s ligament stabilizes the ulnar nerve in the cubital tunnel [4, 5].
  • 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, 5].
  • The anterior capsule attaches at a point approximately 6 mm distal to the tip of the coronoid [4, 5].
  • The joint capsule allows maximum distension at approximately 70 to 80 degrees of flexion [4, 5].
  • Tensile forces are present at the medial elbow and compressive forces at the lateral elbow [4, 5].
  • The triceps muscle has three distinct insertional areas to the olecranon: the posterior capsular insertion, the deep muscular portion, and the 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 and is located 1.1 cm from the tip of the olecranon [2].
  • The brachialis is the strongest elbow flexor and attaches to the coronoid 11 mm distal to the tip [4, 5].
  • The biceps brachii inserts at the ulnar margin of the radial tuberosity [4, 5].
  • The primary elbow extensor, the triceps, inserts on the olecranon process [4, 5].

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].
  • The angulation of the distal humeral articulation accounts for the change from a valgus carrying angle to a more varus position as the elbow is flexed [3].

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 of the elbow [1].
  • Pathologic entities associated with these discrete compartments aid the examiner in detecting pathologic conditions [1].
  • The soft tissue surrounding the elbow should be examined for previous skin incisions, grafts, eschar, or infection [9].
  • 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 should be assessed during the mid-arc or at the terminal ends of motion [9].
  • Mid-arc range of motion pain is more common with intrinsic disease and may not improve with contracture release alone [9].
  • The ulnar nerve is of utmost importance during examination because of 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 [9].
  • Subluxation of the ulnar nerve is a relative contraindication for an arthroscopic procedure secondary to possible iatrogenic nerve injury [9].
  • The presence of a prior ulnar nerve transposition should be verified if there is a history of prior surgical procedures [9].

Imaging

  • Plain radiographs remain the hallmark and the best screening test for elbow evaluation [1].
  • AP, lateral, and oblique radiographs are standard for elbow imaging [9].
  • Serial radiography is used as follow-up when heterotopic ossification is present [9].
  • Primary bony landmarks identified 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].
  • 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].
  • Standard AP and lateral radiographs typically show osteophyte formation at the coronoid process, coronoid fossa, radial fossa, radial head, olecranon tip, and olecranon fossa in elbow osteoarthritis [13].
  • Joint spaces at the ulnohumeral joint are usually preserved in elbow osteoarthritis [13].
  • Joint spaces at the radiocapitellar joint are mildly narrowed in elbow osteoarthritis [13].
  • Loose bodies may be evident on radiographs, which typically underestimate the number present [13].
  • CT may be useful for surgical planning in elbow osteoarthritis, allowing a detailed assessment of osteophytes and the presence of loose bodies [13].

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.

[5] Miller S Review Of Orthopaedics. Genetics of musculoskeletal conditions and abnormalities are summarized in Table 1.27 > 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.

[13] Aaos Comprehensive Orthopaedic Review 3. Arthritis and Arthroplasty of the Elbow > I. Osteoarthritis.

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

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.