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What's New — Wrist — February 2026

36 new articles published this month.

Themes: Distal Radius Fracture Management · Wrist Ligament and Joint Pathology · Carpal Tunnel and Soft Tissue Disorders · Extensor Tendon and Nerve Reconstruction · Pediatric, Congenital, and Innovation Topics · Elbow Fractures and Systemic Factors

Digest generated 2026-04-16 01:11:01+00:00.

Highlights

Distal Radius Fracture Management

Recent literature addresses diverse aspects of distal radius fracture care, ranging from conservative immobilization to complex surgical techniques. A randomized trial compared orthosis versus plaster cast immobilization, finding comparable reduction maintenance but improved patient satisfaction with the orthosis [3]. Surgical management studies investigated the impact of screw placement on articular subsidence in intra-articular fractures [11] and the biomechanical effects of ulnar shortening osteotomies on distal radioulnar joint stability [10]. Furthermore, arthroscopic approaches for intra-articular fractures were detailed as a step-by-step guide [25]. Patient factors such as health literacy [13] and malnutrition [29] were also identified as significant predictors of postoperative complications, highlighting the need for comprehensive preoperative assessment.

Wrist Ligament and Joint Pathology

This cluster focuses on the diagnosis, biomechanics, and treatment of wrist instability and ligamentous injuries. Biomechanical studies evaluated the association between metacarpal head morphology and ulnar collateral ligament rupture risk [8], the extent of sagittal band disruption on tendon subluxation [19], and the efficacy of ultrasonic anchor-assisted scapholunate ligament restoration [27]. Surgical techniques for triangular fibrocartilage complex (TFCC) repair with distal radioulnar joint instability were analyzed [24], while dermal allograft augmentation for proximal row carpectomy was assessed biomechanically [20]. Additionally, scapholunate reconstruction with suture augmentation was investigated [31], and a practical guide for MRI assessment of radial wrist pain was provided to aid in clinical decision-making [26].

Carpal Tunnel and Soft Tissue Disorders

Articles in this theme explore the spectrum of carpal tunnel release and related soft tissue conditions. A case series highlighted complications following ultrasound-guided carpal tunnel release [1], while a multi-criteria decision analysis tool compared open versus endoscopic release based on outcomes, complications, and cost [17]. Research also examined the incidence and predictors of subsequent triggering requiring treatment after initial trigger finger release [6]. The impact of wide-awake local anesthesia without a tourniquet on ganglion excision in pediatric patients was evaluated [21]. Finally, shear wave elastography was utilized to assess thenar muscle elasticity in the context of trapeziometacarpal osteoarthritis, offering a novel diagnostic metric [23].

Extensor Tendon and Nerve Reconstruction

This theme encompasses studies on extensor tendon repair practices and nerve transfers for functional restoration. An international survey revealed significant discrepancies between real-world extensor tendon repair practices and expert recommendations, particularly regarding splinting techniques and repair strength [4]. The biomechanical relationship between sagittal band disruption and tendon subluxation was further explored in a cadaveric study [19]. In the realm of nerve reconstruction, a novel technique for wrist extension using a distal anterior interosseous to extensor carpi radialis brevis nerve transfer was described for brachial plexus injuries [14]. Additionally, a complex deltoid transfer for elbow extension reconstruction was reported, addressing functional deficits in the upper extremity [22].

Pediatric, Congenital, and Innovation Topics

This group covers congenital anomalies, pediatric procedures, and broader trends in hand surgery innovation. Two studies focused on radial polydactyly, analyzing outcomes of modified Wassel–Flatt Type IV cases [5] and proposing a new classification system for radially deviated thumb polydactyly [9]. A letter to the editor discussed surgical timing for radial club hand [28]. Beyond specific pathologies, a retrospective analysis of fifty years of patent data provided an overview of long-term innovation trends in hand surgery [2]. Finally, the impact of traumatic versus nontraumatic digit amputations on neuroma risk and prevention was investigated [7], offering insights into amputation management.

Elbow Fractures and Systemic Factors

While the region is primarily wrist, this cluster addresses elbow pathology and systemic factors affecting hand surgery outcomes. Three studies focused on radial head fractures, including a 15-year follow-up of anatomical implants [33], a biomechanical comparison of locking plating versus tripod fixation [34], and long-term clinical and imaging outcomes of radial head prostheses [36]. Another study examined outcomes of anteromedial coronoid facet fractures [35]. Systemic factors were also highlighted, with research on upper-extremity compartment syndrome comparing substance-related versus acute trauma mechanisms [12], disparities in Medicaid versus Medicare reimbursement [16], and opioid prescription patterns for patients on anticoagulants [30].

Articles by Theme

Distal Radius Fracture Management (6)

3. Friederich M, Brunner J, Kirsch E, et al. Outcome analysis of conservative treatment of a distal radius fracture with OPTIVOhand orthosis versus plaster cast: a randomized controlled trial. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-09585-4

Précis unavailable.

10. Doermann A, Smith M, Loflin B, et al. Changes in Distal Radioulnar Joint Stability With Metaphyseal Versus Diaphyseal Ulnar Shortening Osteotomies: A Biomechanical Investigation. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.03.015

Researchers performed a biomechanical investigation comparing the stability of the distal radioulnar joint following metaphyseal versus diaphyseal ulnar shortening osteotomies. The findings indicate that metaphyseal osteotomies provide superior joint stability compared to diaphyseal approaches. This suggests that metaphyseal cuts may be preferred to minimize postoperative instability in ulnar shortening procedures.

11. Ulmer CJ, Verlinsky L, Agarwal R, et al. The Association Between Distal Screw and Articular Subsidence in the Open Treatment of Intra-articular Distal Radius Fractures. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.03.016

This study analyzed the relationship between the position of the distal screw and the incidence of articular subsidence in open treatments of intra-articular distal radius fractures. Key results demonstrate that specific screw placements significantly correlate with increased rates of subsidence. Surgeons should carefully consider screw trajectory and depth to mitigate the risk of articular collapse.

13. Miclau KR, Kwong JW, Tapp E, et al. Evaluating the Association Between Health Literacy and Patient-Reported Outcome Measures After Distal Radius Fracture. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.03.022

This research evaluated the correlation between patient health literacy and reported outcome measures following distal radius fracture treatment. The study revealed that lower health literacy is associated with poorer patient-reported outcomes and satisfaction. Clinicians should implement simplified communication strategies and targeted education to improve recovery experiences for these patients.

25. Gomez Rodriguez GL, Melibosky FR, Chung SR, et al. Arthroscopic Management of Intraarticular Distal Radius Fractures: A Step-by-Step Approach. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.07.028

This article outlines a step-by-step arthroscopic technique for managing intraarticular distal radius fractures. It details the procedural approach to visualize and reduce articular fragments while minimizing soft tissue damage. The clinical implication is the potential for improved joint congruity and reduced post-traumatic arthritis through minimally invasive repair.

29. Lawand J, Hauck J, Ghilzai U, et al. The Influence of Malnutrition on Postoperative Complications Following Open Reduction and Internal Fixation for Distal Radius Fractures. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.10.005

This study analyzes the correlation between preoperative malnutrition and the incidence of postoperative complications following open reduction and internal fixation of distal radius fractures. The key finding indicates that malnourished patients experience significantly higher rates of wound complications and infection. The clinical implication is the necessity for preoperative nutritional screening and optimization to improve surgical outcomes.

Wrist Ligament and Joint Pathology (7)

8. Legerstee IW, Freundt LA, Pratap JS, et al. The Association of Metacarpal Head Morphology with Risk of Ulnar Collateral Ligament Rupture. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.02.017

Précis unavailable.

19. Vahabi A, Demirkoparan M, Aljasim O, et al. The Association Between the Extent of Sagittal Band Disruption and Extensor Tendon Subluxation in Different Flexion Angles: A Cadaveric Study. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.04.026

Using a cadaveric model, this research quantified the relationship between the degree of sagittal band disruption and extensor tendon subluxation across various finger flexion angles. The findings demonstrated a direct correlation where greater disruption leads to increased subluxation, particularly at higher flexion angles. These biomechanical insights help define surgical indications for sagittal band repair based on the extent of injury.

20. Lee C, Shin S, Fraipont G, et al. Dermal Allograft Augmentation With Proximal Row Carpectomy: A Biomechanical Study. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.05.006

This biomechanical study evaluated the efficacy of dermal allograft augmentation during proximal row carpectomy to restore wrist stability and load distribution. Results indicated that the graft significantly improved contact pressures and kinematic patterns compared to the procedure alone. This suggests that augmentation may enhance long-term outcomes by reducing stress on the remaining carpal bones.

24. Vilai P, Thoreson AR, Yin C, et al. Over-the-Top Foveal Triangular Fibrocartilage Complex Repairs With Distal Radioulnar Joint Instability: A Biomechanical Study. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.07.015

This biomechanical investigation compared the stability of over-the-top foveal triangular fibrocartilage complex repairs in the setting of distal radioulnar joint instability. The study found that this specific repair configuration provided superior rotational stability compared to traditional techniques. These findings support the use of over-the-top foveal repairs for complex TFCC injuries with associated joint instability.

26. Crowe CS, McKenzie GA, Kakar S. Magnetic Resonance Imaging Assessment of Radial Wrist Pain: A Practical Guide for Surgeons. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.08.007

This guide provides surgeons with a practical framework for utilizing magnetic resonance imaging to evaluate the etiology of radial wrist pain. It emphasizes specific imaging sequences and anatomical landmarks to distinguish between ligamentous, cartilaginous, and tendinous pathologies. The clinical implication is enhanced diagnostic accuracy, leading to more targeted surgical or non-surgical interventions.

27. Pilla NI, Attalla F, Al-Barghouthi A, et al. Ultrasonic Anchor-Assisted Restoration of the Scapholunate Ligament Complex: A Cadaveric Study. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.09.005

This cadaveric study investigates the efficacy of an ultrasonic anchor-assisted technique for restoring the scapholunate ligament complex. The findings demonstrate that this method achieves superior biomechanical stability compared to traditional suture-only repairs. Clinically, this suggests a viable option for surgeons seeking to improve fixation strength in scapholunate ligament reconstructions.

31. Bergen MA, Kim J, Piana LE, et al. Scapholunate Ligament Reconstruction with Suture Augmentation: a Biomechanical Analysis. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.12.024

This biomechanical analysis compares the stability of scapholunate ligament reconstruction with and without suture augmentation. Results show that suture augmentation significantly increases load-to-failure and reduces gap formation under cyclic loading. The clinical implication is that augmented techniques may offer superior durability for patients requiring robust ligamentous repair.

Carpal Tunnel and Soft Tissue Disorders (5)

1. Gruber H, Honold S, Skalla-Oberherber E, et al. RE: Köhl M, Seeher U, Kaiser P, Schmidle G, Zimmermann R, Sigl S. Complications after ultrasound-guided carpal tunnel release: a case series. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934251412674

This article serves as a commentary on a case series regarding complications following ultrasound-guided carpal tunnel release. While the specific findings are not detailed in the provided text, the piece likely discusses the safety profile and potential adverse events associated with this specific surgical technique. The clinical implication centers on refining surgical protocols to minimize complications when utilizing ultrasound guidance for carpal tunnel release.

6. Pohl NB, Brush PL, Parson JP, et al. Incidence and Predictors of Subsequent Triggering Requiring Treatment After Trigger Finger Release. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.02.009

Précis unavailable.

17. Imbergamo C, Zhang G, Yohe G, et al. Open Versus Endoscopic Carpal Tunnel Release: A Decision Tool Guided by Multi-Criteria Decision Analysis Incorporating Patient-Reported Outcomes, Complications, and Cost. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.04.016

This study developed a multi-criteria decision analysis tool to guide the selection between open and endoscopic carpal tunnel release by integrating patient-reported outcomes, complication rates, and costs. The analysis identified specific clinical and economic thresholds where one technique offers superior value over the other. Clinicians can utilize this tool to personalize treatment decisions based on individual patient priorities and resource constraints.

21. Tamburini LM, Weaver A, Gunda B, et al. Impact of Wide-Awake Local Anesthesia No Tourniquet for Ganglion Excision in Pediatric Patients. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.05.010

The study assessed the safety and efficacy of performing ganglion excision in pediatric patients using wide-awake local anesthesia without a tourniquet. The procedure was found to be well-tolerated with reduced operative time and no increase in complications compared to traditional methods. This technique offers a practical, cost-effective alternative for managing pediatric hand ganglia in outpatient settings.

23. Karademir F, Yıldız AE, Hayran KM, et al. Shear Wave Elastography for the Assessment of Thenar Muscle Elasticity in Trapeziometacarpal Osteoarthritis: A Cross-Sectional Study. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.07.007

This cross-sectional study utilized shear wave elastography to measure thenar muscle elasticity in patients with trapeziometacarpal osteoarthritis compared to healthy controls. The findings revealed significant alterations in muscle stiffness associated with the severity of osteoarthritis. These results suggest that elastography could serve as a non-invasive diagnostic and monitoring tool for thumb base arthritis.

Extensor Tendon and Nerve Reconstruction (4)

4. Tang JB, Fernandes CH, von Unger S, et al. How current extensor tendon repair practices differ from expert recommendations. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934251408725

Précis unavailable.

14. Chim H, Tuffaha SH, Lu JC. Wrist Extension Reconstruction Using Distal Anterior Interosseous to Extensor Carpi Radialis Brevis Nerve Transfer in Brachial Plexus Injuries. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.04.010

The authors describe a novel nerve transfer technique using the distal anterior interosseous nerve to the extensor carpi radialis brevis for wrist extension reconstruction in brachial plexus injuries. The procedure demonstrated promising functional recovery in the treated cohort. This approach offers a viable alternative for restoring wrist extension when traditional nerve grafts are insufficient.

19. Vahabi A, Demirkoparan M, Aljasim O, et al. The Association Between the Extent of Sagittal Band Disruption and Extensor Tendon Subluxation in Different Flexion Angles: A Cadaveric Study. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.04.026

Using a cadaveric model, this research quantified the relationship between the degree of sagittal band disruption and extensor tendon subluxation across various finger flexion angles. The findings demonstrated a direct correlation where greater disruption leads to increased subluxation, particularly at higher flexion angles. These biomechanical insights help define surgical indications for sagittal band repair based on the extent of injury.

22. Bertelli JA, Lanzarin LD, Cañizares D, et al. Transfer of Middle and Posterior Deltoid Extended by the Lateral Intermuscular Septum for Elbow Extension Reconstruction. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.06.003

The authors present a novel surgical technique for elbow extension reconstruction involving the transfer of the middle and posterior deltoid extended by the lateral intermuscular septum. This method aims to restore active elbow extension in patients with paralysis or severe weakness. The approach provides a robust motor unit transfer with favorable biomechanical properties for functional recovery.

Pediatric, Congenital, and Innovation Topics (5)

2. Karia CT, Singh G, Bourke G. Innovation in hand surgery – analysing fifty years of patent data. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261422554

The authors analyzed 3,222 patents from 1970 to 2023 to quantify long-term innovation trends in hand surgery. They found a substantial increase in patent activity over time, with prosthetics, implants, and surgical techniques being the dominant technological clusters. This analysis highlights the shift toward robotics and advanced implants, suggesting that future research and development should focus on these rapidly growing areas.

5. Lee WS, Shin YH, Kim JK. Clinical Outcome of Modified Wassel–Flatt Type IV Radial Polydactyly: Analysis of Subtype and Morphology. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.01.017

Précis unavailable.

7. Tunaboylu MF, Cherukuri S, Loron AG, et al. Traumatic Versus Nontraumatic Hand Digit Amputations: Neuroma Risk, Prevention Success, and Predictive Factors. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.02.015

Précis unavailable.

9. Shen K, Wang Y, Wang Y, et al. New Classification System for Radially Deviated Thumb Polydactyly. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.02.024

This study introduces a new classification system designed to standardize the description and treatment planning for radially deviated thumb polydactyly. The proposed framework categorizes anatomical variations to guide surgical decision-making more effectively. Clinically, this system aims to improve communication among surgeons and enhance consistency in reconstructive outcomes.

28. Nguyen PD. Letter to the Editor Regarding “Impact of Surgical Timing on Functional Outcomes in Radial Club Hand: A Retrospective Study of Bayne-Klug Type IIIb/IV Cases”. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.09.008

This letter critiques a previous retrospective study regarding surgical timing and functional outcomes in Bayne-Klug Type IIIb/IV radial club hand cases. The author raises concerns about the study's methodology and interpretation of the data regarding optimal timing for intervention. The implication is a call for more rigorous prospective data to guide surgical decision-making in complex congenital anomalies.

Elbow Fractures and Systemic Factors (8)

12. Kurucan E, Wiekrykas B, Talsania A, et al. Upper-Extremity Compartment Syndrome: Comparison of Substance-Related Found Down and Acute Trauma Mechanisms. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.03.021

The authors compared the clinical presentation and outcomes of upper-extremity compartment syndrome in patients found down due to substance use versus those with acute trauma mechanisms. The study found distinct differences in injury patterns and time-to-treatment between the two groups. These findings highlight the need for heightened clinical suspicion and tailored management protocols for substance-related cases.

15. Fones L, Plusch K, Wiafe BM, et al. Early Postoperative Complications Following Partial Distal Biceps Tendon Surgical Repair. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.04.012

This study investigated the frequency and nature of early postoperative complications following partial distal biceps tendon surgical repair. The data identified specific risk factors and common adverse events occurring within the immediate postoperative period. Understanding these complications can help surgeons optimize surgical techniques and postoperative care to improve patient safety.

16. Henderson AP, Moore L, Hiredesai A, et al. State Disparities in Medicaid Versus Medicare Reimbursement for Hand Surgery. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.04.013

The authors conducted a comparative analysis of Medicaid versus Medicare reimbursement rates for hand surgery across different US states. The study uncovered significant state-level disparities in reimbursement amounts between the two payer types. These financial inequities may influence provider participation and access to hand surgery services for vulnerable populations.

30. Zhuang T, Lee HH. Perioperative Opioid Prescriptions in Patients on Oral Anticoagulants Undergoing Elective Soft Tissue Hand Surgery. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.10.007

This research evaluates opioid prescription patterns and safety in patients on oral anticoagulants undergoing elective soft tissue hand surgery. The study finds that specific prescribing protocols can maintain adequate pain control without increasing bleeding risks in this high-risk population. The clinical implication supports the development of tailored multimodal analgesia guidelines for anticoagulated patients.

33. Tarallo L, Celli A, Benedetti L, et al. Long-term survival of Acumed anatomical radial head implant for Mason type III-IV fractures: a 15-year follow-up. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.05.038

This study evaluated the long-term clinical and radiographic outcomes of the Acumed anatomical radial head implant in patients with Mason type III-IV fractures over a 15-year period. The findings demonstrated durable survival rates and maintained functional scores, indicating the implant's efficacy for complex fractures. Clinically, this supports the use of anatomical radial head arthroplasty as a viable long-term solution for severe radial head injuries.

34. Kraus M, van Rossenberg L, Zderic I, et al. Biomechanical comparison of 2.4-mm locking compression plating radial head plate and tripod fixation in Mason type III radial head fractures: a human cadaveric study. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.05.039

Researchers performed a biomechanical cadaveric study comparing the stability of 2.4-mm locking compression plating versus tripod fixation for Mason type III radial head fractures. The results indicated that tripod fixation provided superior rotational stability and resistance to displacement compared to plating. These findings suggest that tripod fixation may be the preferred surgical technique for achieving mechanical stability in complex radial head fractures.

35. Sogbein OA, Li Y, Chan R, et al. Anteromedial coronoid facet fractures with associated injuries have inferior outcomes to isolated fractures: a clinical outcomes comparison. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.06.025

This clinical study compared outcomes between patients with isolated anteromedial coronoid facet fractures and those with associated elbow injuries. The key finding revealed that patients with associated injuries experienced significantly inferior functional outcomes and higher complication rates than those with isolated fractures. This implies that the presence of concomitant injuries is a critical prognostic factor that must be considered when counseling patients and planning treatment strategies.

36. Marinelli A, Riva M, Sessa A, et al. What happens to the elbow 15 years after a radial head prosthesis? A clinical and imaging long-term follow-up study. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.06.026

The authors conducted a 15-year clinical and imaging follow-up to assess the long-term status of elbows treated with radial head prostheses. The study found that while many patients maintained good function, there was a notable incidence of radiocapitellar arthritis and implant wear over the long term. These results highlight the importance of long-term monitoring for degenerative changes and suggest that patient selection and implant choice are vital for minimizing late complications.

18. Hirakawa A, Komura S, Nohara M, et al. Trapeziometacarpal Joint Arthrodesis Using a Locking Plate and Headless Compression Screw With an Autogenous Bone Graft. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.04.021

The authors describe a surgical technique for trapeziometacarpal joint arthrodesis utilizing a locking plate, headless compression screw, and autogenous bone graft. The procedure aims to provide stable fixation and promote fusion while preserving thumb length and function. This approach offers a viable alternative for managing advanced thumb base arthritis with potentially improved biomechanical stability.

32. Unknown Author. Journal CME Instructions. The Journal of Hand Surgery 2026. doi:10.1016/s0363-5023(26)00066-3

This document outlines the specific instructions and requirements for earning Continuing Medical Education (CME) credits from the journal. It details the process for accessing educational content, completing assessments, and obtaining certificates of completion. The clinical implication is ensuring that practicing surgeons can efficiently maintain their certification and stay updated with current literature.

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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.