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Fusion ng DIP Joint

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DIP joint fusion stabilizes and reduces pain in the fingertip joint, often for arthritis or mallet finger.

Updated Sep 2026
Isang hand-drawn na ilustrasyon ng isang taong walang mukha na sinusubukang pumulot ng isang maliit na barya gamit ang mga dulo ng daliri na matigas.
Ikinakandado ng fusion ang maliit na joint na pinakamalapit sa kuko sa iisang solidong yunit, na nag-aalis ng sakit kapalit ng kakayahang ibaluktot ito. Kieran Hirpara 4.0

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 nagsisimula sa mga opsyon na hindi gaanong invasive na angkop sa iyong kondisyon. 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 kamay, at nagsasaayos ng imaging kung kinakailangan upang malaman kung ano ang problema.

Ang operasyong ito ay isang fusion ng dulo ng joint ng daliri o thumb. Ang dalawang buto sa magkabilang panig ng joint ay pinagsasama upang gumaling ang mga ito bilang isang solidong buto. Kapag gumaling na ito, ang joint ay hindi na mababaluktot, ngunit hindi na rin ito sasakit.

Karaniwan naming iminumungkahi ang operasyong ito kapag ang joint ay pudpod na, malubhang napinsala ng injury, o unstable, at ang mga mas simpleng hakbang tulad ng pagbabago sa aktibidad, hand therapy o splinting ay hindi nagbigay ng sapat na ginhawa. Para sa ilang acute injuries, ang surgery ay maaaring maging tamang pagpipilian agad. Ang layunin ay isang daliri na matatag, komportable at kayang gampanan ang tungkulin nito kapag ikaw ay pumipit (pinch) at humahawak (grip).

Bago ang operasyon

Sa mga linggo bago ang operasyon, kumpirmado namin ang plano gamit ang mga bagong X-ray ng iyong daliri. Karamihan sa mga pasyente ay wala nang kailangan pa maliban dito. Kung mayroon kang ibang kondisyong medikal, maaaring kailanganin mo ng mga blood test o pagsusuri kasama ang anaesthetist (ang espesyalistang doktor na tinitiyak na ikaw ay ligtas at walang nararamdamang sakit habang isinasagawa ang operasyon). Hihilingin sa iyo na itigil ang pagkain at pag-inom pitong oras bago ang operasyon; humihiling kami ng mas matagal nang kaunti kaysa sa karaniwang anim na oras upang maaaring ilipat nang mas maaga ang iyong oras kung maagang matapos ang listahan sa theatre. Sasabihin sa iyo ng iyong surgeon kung alin sa iyong mga regular na gamot ang dapat itigil, kaya magdala ng nakasulat na listahan ng lahat ng iyong iniinom. Mag-ayos ng sasakyan pauwi, dahil hindi ka maaaring magmaneho pagkatapos. Magsuot ng maluwag at komportableng damit na madaling maisuot sa kamay na may benda.

Sa araw ng operasyon

Pupunta kayo sa surgical admissions unit ng ospital, kung saan kayo ay ire-rehistro at ihahanda para sa theatre. Pagkatapos ay makikipagkita kayo sa anaesthetist (ang espesyalistang doktor na titiyak na kayo ay ligtas at walang nararamdamang sakit habang isinasagawa ang operasyon). Karamihan sa mga tao ay pumipili ng local: mas mabilis ang paggaling at maaari kayong umuwi agad pagkatapos. Kung mas gusto ninyong nakatulog, isa rin itong makatwirang pagpipilian; talakayin ito sa inyong surgeon at anaesthetist.

Pagkatapos ay dadalhin kayo sa operating theatre, kung saan isasagawa ang operasyon. Pagkatapos nito, magigising kayo sa recovery area, kung saan babantayan kayo ng mga nurse habang nawawala ang bisa ng anaesthetic. Kapag stable na kayo, maaaring ilipat kayo sa ward o pauuwiin na, depende sa procedure at kung paano ang takbo ng inyong paggaling.

Ano ang kinapapalooban ng operasyon

Ang iyong surgeon ay gagawa ng isang hiwa sa dulo ng kasukasuan (joint) ng iyong daliri o hinlalaki. Sa pamamagitan ng hiwang ito, tatanggalin nila ang mga gasgas o pudpod na surface ng kasukasuan upang ang mga hilaw na buto sa bawat panig ay magtagpo.

Ang dalawang buto ay pagdidikitin habang gumagaling ang mga ito upang maging isang solidong buto. Ang mga maliliit na metal implant, gaya ng screw o low-profile plate, ang nagpapanatili sa mga buto na magkadikit at nasa tamang posisyon. Ang kasukasuan ay itatakda sa isang kurbada na angkop sa kung paano mo ginagamit ang iyong kamay sa pag-pinch at pag-grip, at ang posisyon ay maaaring i-fine-tune bago tuluyang ilagay ang mga implant.

Ang hiwa ay sasara gamit ang mga tahi, at lalagyan ng dressing sa ibabaw nito.

Pagkatapos ng operasyon

Karamihan sa mga pasyente ay nananatili ng isang gabi sa ospital pagkatapos ng operasyong ito, bagaman ang ilan ay nakakauwi sa mismong araw. Magigising ka sa recovery area, kung saan babantayan ka ng mga nars habang nawawala ang bisa ng anaesthetic. Ang iyong kamay ay mabibendahan, at ang daliri ay karaniwang sinusuportahan ng isang splint (isang matigas na takip na pinapanatili itong hindi gumagalaw habang naghihilom). Ang pain relief ay pinaplano kasama ka bago ka lumabas ng theatre, at maaaring dagdagan ito ng mga nars kung kailangan mo pa. Dapat may kasama ka sa unang 24 oras. Maaari ka nang gumalaw at gamitin ang iyong kamay nang dahan-dahan sa oras na maramdaman mong kaya mo na. Hinahayaan 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.

Paggaling

Sa unang ilang araw, ang iyong daliri ay magiging masakit at mamamaga, at maaaring kumibot-kibot ang dulo ng kasukasuan. Ang pagpapahinga ng iyong kamay na nakataas sa isang unan ay nakababawas nito, at ang iyong nakasanayang pain relief ay magpapanatili sa iyong pagiging komportable. Ang pamamaga ay unti-unting huhupa sa mga sumunod na linggo.

Uuwi ka na may splint (isang matigas na pantakip na nagpapanatiling hindi gumagalaw sa daliri habang ito ay gumagaling) at may benda ang kamay. Panatilihing tuyo ang dressing at huwag itong galawin hanggang sa makita ka namin. Si Ruby Doolan, ang aming hand therapist sa Extend Rehabilitation, ang magdidirekta ng iyong rehabilitasyon at gagawa ng anumang splint na iyong kakailanganin. Tuturuan ka niya ng mga banayad na ehersisyo upang mapanatiling gumagalaw ang ibang bahagi ng iyong kamay at mga daliri habang gumagaling ang fused joint.

Sa araw-araw, maaari mong gamitin ang iyong kabilang kamay para sa karamihan ng mga gawain. Maaari kang gumalaw sa loob ng bahay, magbihis nang mag-isa, at maghanda ng mga simpleng pagkain. Iwasan ang pagbubuhat ng mabibigat, mahigpit na paghawak, o pagbabasa ng dressing. Ang pagtulog nang ang iyong kamay ay nasa unan o nakasandal ay maaaring makabawas sa kumibot-kibot na pakiramdam sa gabi.

Isusuot mo ang splint hanggang sa ang mga buto ay magdugtong na bilang isang solidong buto. Kapag naalis na ito at binigyan ka na ng clearance ng iyong surgeon, maaari ka nang magmaneho muli, basta't kaya mong hawakan ang manibela nang ligtas. Tingnan ang aming pahina sa Driving after upper-limb surgery.

Ang bawat isa ay gumagaling sa sarili nilang bilis, kaya maaaring mag-iba ang iyong timeline. Gagabayan ka ng iyong surgeon at hand therapist sa bawat review.

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 pangunahing binabantayan namin ay ang hindi pagdidikit ng mga buto upang maging isang solidong buto. Kung mangyari ito, maaaring manatiling masakit ang dulo ng joint ng daliri, o maaari kayong makaramdam ng click, paggalaw, o pagkiskis (grinding) kung saan ay hindi dapat ito nararamdaman. Sabihin sa amin sa inyong review kung hindi nawawala ang sakit o kung pakiramdam ninyo ay maluwag ang joint. Minsan, ang mga buto ay nagdidikit sa posisyong bahagyang naiiba sa pinlano. Ang daliri ay maaaring magmukhang pilipit o nakahilig sa isang panig, na maaaring magpahirap sa pag-align nito sa inyong ibang mga daliri kapag nagkuyom kayo ng palad. Banggitin ito sa inyong susunod na appointment.

Ang mga metal implant ay maaari ring magdulot ng problema. Ang isang screw o plate ay maaaring lumuwag, lumabas, o pumuwersa sa balat, at maaari kayong makaramdam ng matalim na gilid sa ilalim ng balat o makitang tumutulak ang implant palabas. Kung mangyari ito, makipag-ugnayan sa klinika. Ang pagtanggal ng implant ay isang maliit na karagdagang operasyon, at pag-uusapan namin ito nang detalyado kasama kayo.

Ang impeksyon ay hindi karaniwan ngunit nangangailangan ng mabilis na atensyon. Bantayan ang sakit na patuloy na lumalala sa halip na humuhupa, pamumula na kumakalat mula sa sugat, pamamaga na nadaragdagan sa halip na nababawasan, o likidong tumatagas mula sa hiwa. Maaari kayong makaramdam ng lagnat at pangkalahatang panghihina. Huwag nang hintayin ang inyong review: tumawag agad sa klinika, o pumunta sa emergency department kung hindi ninyo kami maabot.

May ilang kondisyon na nagpapataas ng posibilidad ng mga problema. Isa na rito ang diabetes, kaya nag-iingat kami nang husto sa pagpaplano ng operasyon kung mayroon kayo nito. Ang inyong pangkalahatang kalusugan at ang pagiging kumplikado ng operasyon ay may kinalaman din, kaya naman maingat naming sinusuri kung ang operasyong ito ay angkop para sa inyo bago ito ituloy.

Kung lumitaw ang alinman sa mga senyales na ito, huwag itong ituring na normal na bahagi ng paggaling. Tumawag sa amin, at pakikikita namin kayo nang mas maaga kung kinakailangan.

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 problema ay lumalabas sa unang ilang linggo. Tumawag sa amin kung ang iyong sakit ay patuloy na lumalala sa halip na humupa, kung ang pamumula ay kumakalat mula sa sugat, o kung may likidong lumalabas mula rito. Tumawag sa amin kung nakararamdam ka ng lagnat at pangkalahatang panghihina, o kung ang daliri ay namamanhid, lumalamig o nagbabago ang kulay. Pumunta sa emergency kung hindi mo kami maabot, o kung ang pamamaga ay malala at biglaang nangyari. Magtiwala sa iyong kutob: kung may nararamdamang hindi tama, tumawag sa amin.

Saan maaaring magbasa nang higit pa tungkol sa kondisyon

Ang pahinang ito ay tungkol sa operasyon mismo. Ang kondisyong ginagamot nito, kabilang ang kung ano ang ipinapakita ng ebidensya tungkol sa kung kailan nakatutulong ang operasyon at kung kailan hindi, ay tinalakay nang mas detalyado sa pahinang DIPJ arthritis.

Reviewed by AI synthesis (v2) — pending human review · 18 May 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 and Articular Anatomy

  • The hand consists of 19 bones, 17 articulations, and 19 muscles situated entirely within the hand [2].
  • Each finger ray is a polyarticular chain composed of a metacarpal and three phalanges [2].
  • The distal interphalangeal (DIP) joint is the most distal articulation in the finger ray [2].
  • The dorsal integument of the distal phalanx is characterized by the presence of the nail bed and its matrix [3].
  • The MCP joint contributes 77% of the total arc of finger flexion [18].
  • Studies indicate that 5 to 10 degrees of flexion and 30 to 35 degrees of extension are needed for most activities of daily living [18].

Soft Tissue Anatomy

  • The terminal tendon inserts at the base of the distal phalanx to extend it [4].
  • The two conjoined lateral bands to each finger unite at the distal third of the middle phalanx to form the terminal tendon [4].
  • The dorsal covering of the interphalangeal articulations forms a unique cutaneous unit characterized by a considerable excess of skin when the digits are in extension [3].
  • The fine tight skin of the dorsal aspect of the middle phalanx forms a distinct functional cutaneous unit [3].
  • The skin covering each finger is 7 cm by 10 cm on both the palmar and dorsal aspects [6].
  • The necessary skin to cover the thumb distal to the metacarpophalangeal joint is about 9 cm wide and 8 cm long [6].

Extensor Mechanism and Pathomechanics

  • The deep head of each dorsal interosseous muscle extends the middle and distal phalanges [4].
  • The superficial head of the dorsal interosseous muscle has no direct effect on the middle or distal phalanges [4].
  • Boutonnière deformities primarily arise at the PIP joint when stretching of the extensor tendon over the joint induces hyperextension of the DIP and MCP joints [17].
  • Acute boutonnière deformity results from central slip disruption and volar subluxation of the lateral bands, resulting in DIP hyperextension [15].
  • In boutonnière deformity, attenuation of the central slip results in unopposed flexion at the PIP joint [16].
  • With PIP joint flexion in boutonnière deformity, the lateral bands drift volar to the axis of rotation at the PIP joint [16].
  • The lateral bands stay in the volar position owing to loss of dorsal support from the attenuated triangular ligament and contracture of the transverse retinacular ligament [16].
  • Swan neck deformities can occur at the DIP, PIP, and MCP joints as a result of multiple etiologies [13].
  • Synovitis can cause a flexion deformity at the DIP joint [13].
  • A zigzag deformity propagates proximally because there is stretching of the terminal tendon [13].
  • In type I swan neck deformity, the deformity can originate at the DIP joint with stretching or rupture of the terminal extensor tendon attachment, resulting in a mallet deformity [14].
  • Imbalance of the extensor mechanism secondary to DIP joint flexion coupled with laxity of the PIP joint volar plate allows the PIP joint to assume a posture of hyperextension [14].

Functional Considerations

  • DIP fusion of the digits is generally tolerated well with limited loss of function [18].
  • PIP joint motion is much more important to preserve than DIP joint motion [18].
  • Fingers with fused PIP joints are of little use for grip or grasp and frequently get in the way [18].
  • The quadriga effect can occur when profundus excursion is impaired with arthrodesis [18].
  • Even with a successful DIP fusion, the fine motor skills of a finger may be compromised [14].

Clinical Presentation

Physical Examination

  • Inspection of the dorsal and palmar surfaces of the hand is the initial step in physical examination [19].
  • Swelling and volar subluxation may be present at the metacarpophalangeal (MCP) joints in osteoarthritis [19].
  • Flexion contracture or extension lag may be associated with MCP joint swelling and volar subluxation [19].
  • Proximal interphalangeal (PIP) joints may display flexion contractures in osteoarthritis [19].
  • The Bouchard node is a distinguishing characteristic of osteoarthritic PIP joints [19].
  • The presence of Heberden nodes heralds inspection of the osteoarthritic distal interphalangeal (DIP) joint [19].
  • Heberden nodes signify swelling and periarticular osteophyte formation at the DIP joint [19].
  • Mucous cyst formation may occur in relation to an osteoarthritic DIP joint [19].
  • Palpation of an acutely inflamed osteoarthritic DIP joint elicits tenderness [19].
  • Palpation of an acutely inflamed osteoarthritic DIP joint elicits a sensation of fullness about the joint [19].
  • Palpation of an acutely inflamed osteoarthritic DIP joint reveals loss of the normal bony contour of the joint [19].
  • The examiner can detect tenderness and synovitis by applying small pressure while holding the joint between the dominant thumb and index finger [19].
  • Range of motion of each joint may be limited due to a superimposed flexion contracture [19].
  • Digital range of motion is often expressed in terms of total active range of motion, approximately 250 degrees [19].
  • Normal DIP joint range of motion is 0 to 60 degrees [19].
  • Tendon integrity may be compromised in the osteoarthritic hand [19].
  • Chronic tenosynovitis of the flexor tendon uncommonly coexists with a zone 2 flexor digitorum superficialis (FDS) or flexor digitorum profundus (FDP) tendon rupture [19].
  • Extensor tendons are more commonly involved in osteoarthritic hands [19].
  • Ulnar subluxation of extensor tendons at the level of the MCP joints occurs secondary to failure of the sagittal bands [19].
  • Ulnar drift and flexion positioning of the digits at the level of the MCP joints result from extensor tendon subluxation [19].
  • In the acute phase, extensor tendon subluxation and ulnar drift/MCP flexion may be passively correctable [19].
  • In the acute phase, extensor tendon subluxation and ulnar drift/MCP flexion are amenable to individual MCP extension splinting for 3 weeks [19].
  • In the chronic situation, the only treatment option is surgical release of the tight sagittal bands [19].
  • Surgical release of tight sagittal bands in chronic cases may be performed with or without intrinsic releases [19].
  • Surgical release of tight sagittal bands in chronic cases may be performed with extensor tendon realignment [19].

Erosive or Inflammatory Osteoarthritis

  • Erosive or inflammatory osteoarthritis is an uncommon variant of osteoarthritis first described in 1966 by Peter and coworkers [19].
  • Erosive or inflammatory osteoarthritis is more common in women [19].
  • Symptoms of erosive or inflammatory osteoarthritis appear abruptly [19].
  • Erosive or inflammatory osteoarthritis involves the joints on the radial aspect of the hand [19].
  • Erosive or inflammatory osteoarthritis spares the joints on the ulnar side [19].
  • The DIP joint is the most commonly affected joint in erosive or inflammatory osteoarthritis [19].
  • The PIP joint is the most commonly symptomatic joint in erosive or inflammatory osteoarthritis [19].
  • In some patients, erosive osteoarthritis will seroconvert to rheumatoid arthritis at a later time [19].

Diagnostic Imaging

  • Plain posteroanterior (PA), lateral, and oblique radiographic views can adequately image the osteoarthritic hand [19].
  • Further detail can be obtained by directly imaging the individual digit [19].
  • Direct imaging of the individual digit involves an attempt to center the radiograph beam over the joint in question [19].

Investigations

  • Clinical evaluation of the injured or dysfunctional hand and wrist requires combining patient history with a careful physical examination to pinpoint or narrow the scope of possible pathologic processes [1].
  • Diagnostic tests such as imaging and serum laboratory studies are useful in determining pathology but can be expensive, time consuming, and often nonspecific [1].
  • A careful physical examination is essential to direct care and future testing if indicated [1].
  • The skeleton of the hand and wrist consists of 27 bones, of which 19 are long bones [12].
  • The skeleton is divided into five rays, each ray making up a polyarticulated chain comprising the metacarpals and phalanges [12].
  • The base of each metacarpal articulates with the distal row of the carpus [12].
  • The carpus articulates with the skeleton of the forearm through its proximal row [12].
  • The radioulnocarpal articulation has two axes of movement to which is added a third—pronation and supination from the forearm [12].
  • The wrist has three axes of movement, permitting the hand to be positioned in any spatial configuration and allowing it to be placed as needed for grasping [12].
  • The radial ray or first ray is the shortest and is made up of only three bones—a metacarpal and two phalanges [12].
  • The other four digital rays are formed by four skeletal segments—a metacarpal and three phalanges [12].
  • The thumb metacarpal is the shortest, the index finger metacarpal is the longest, and the others decrease in length from the third to the fifth digits [12].
  • The proximal and particularly the middle phalanges of the middle and ring fingers are longer than those of the index finger [12].
  • The long finger, and usually the ring finger, are longer than the index finger [12].
  • The epiphyseal plates are located at the proximal ends of the phalanges and the first metacarpal [12].
  • The epiphyseal plates are located at the distal ends of the other metacarpals [12].

References

[1] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Evaluation, Clinical Examination, and Imaging > Evaluation and Clinical Examination: Current Concepts.

[2] Exam Of The Hand Wrist 2Ed. INTRODUCTION.

[3] Exam Of The Hand Wrist 2Ed. Functional cutaneous units.

[4] Green S Operative Hand Surgery. Interosseous and Hypothenar Muscles.

[6] Exam Of The Hand Wrist 2Ed. Planning skin cover of the hand and forearm.

[12] Exam Of The Hand Wrist 2Ed. 1.1 SKELETON OF THE HAND > The osseous skeleton.

[13] Green S Operative Hand Surgery. Swan Neck Deformities.

[14] Green S Operative Hand Surgery. Swan Neck Deformities > Postoperative Care.

[15] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > TENDON INJURIES AND OVERUSE SYNDROMES > Zone III injury (boutonnière).

[16] Miller S Review Of Orthopaedics. TENDON INJURIES AND OVERUSE SYNDROMES > Zone III injury (boutonnière).

[17] Green S Operative Hand Surgery. Boutonnière Deformities.

[18] Green S Operative Hand Surgery. EVOLUTION IN THE TREATMENT OF MANGLING INJURIES > Joints.

[19] Green S Operative Hand Surgery. Treatment of the Osteoarthritic Hand and Thumb > OSTEOARTHRITIS OF THE SMALL JOINTS OF THE HAND.

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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.