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Intertrochanteric fracture

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Updated Sep 2026
Illustration: hip

What you're feeling

An intertrochanteric fracture is a break in the upper part of your thigh bone, just below the hip ball. It happens in the wide part of the bone where two rows of muscle attach. These breaks make up 40% to 50% of all hip fractures.

The pain sits deep in your hip and the top of your thigh, often spreading toward your groin or the side of your hip. Standing, walking, and taking your weight through that leg usually make it worse. Lying still tends to ease it, though many people find the pain flares at night or when they first wake and try to move. Getting out of bed or a chair, stepping into the shower, and climbing stairs become hard because your hip won't take your weight smoothly. You may not be able to walk at all without help.

Most of these fractures happen after a fall, but some develop slowly. If your bones are thin (a condition called osteoporosis), the bone can crack under ordinary load before any fall. These stress-type breaks are easy to miss on plain X-rays, and sometimes a scan is needed to see them clearly.

Swelling and bruising around the hip are common. Your leg may look shorter or turned outward, because the broken bone can no longer hold the limb in line.

The hip is close to large blood vessels, and these fractures can lose more blood than you might expect, which can leave you feeling washed out or dizzy. If you are older or have heart or memory problems, your general health matters as much as the break itself in how you recover.

If you cannot stand or put weight on your leg after a fall or a stumble, arrange to be seen straight away.

What's actually happening

Your hip is a ball-and-socket joint. The ball sits at the top of your thigh bone, and just below it the bone narrows into a neck before widening out again. The two bumps on that wide part are called trochanters. They are the anchor points where your hip muscles attach. An intertrochanteric fracture is a break in the bone between those two bumps.

This part of the bone is outside the hip joint capsule, and it has a rich blood supply. That matters in two ways. The fracture can bleed more than you might expect, which explains the washed-out feeling described above. It also means this area usually heals well once the pieces are held in the right position, because plenty of blood reaches the break.

When the bone breaks, the muscles attached to those bumps keep pulling on the pieces. One set of muscles pulls the bone up and outwards, another pulls it down and inwards. The result is that the broken ends slide out of line, which is why your leg may look shorter or turned outward. The amount the bone is out of place depends on how much force went through it. A break where a large piece of bone is pulled away from the lower bump tends to take longer to settle than one where that piece stays in place, though that difference fades with time.

Most of these breaks happen when a fall drives your full body weight through the top of the thigh bone. If your bones are thin from osteoporosis, the inner scaffolding of the bone is weaker, so ordinary loading can crack it without any fall at all.

Because the break sits outside the joint itself, the smooth cartilage surface of the hip is usually not damaged. The problem is the broken bone and the pulling muscles around it, not the joint surface.

What we can do about it

Most intertrochanteric fractures need surgery, and we usually recommend it soon after the injury. Before the operation, X-rays of your hip show where the bone is broken and how far the pieces have moved. If the X-rays don't give enough detail, a CT scan can map the break in three dimensions and help plan the repair. If we suspect a hidden crack that plain X-rays miss, an MRI scan can show it clearly.

Surgery holds the broken bone in the right position while it heals, so your hip muscles can work again and you can put weight on your leg. The most common option is a metal nail placed down the centre of your thigh bone, with a screw that grips the ball end and lets it slide and settle as the bone knits. For some stable breaks, a plate and screws on the outside of the bone works just as well and tends to lose less blood during surgery. The choice depends on your fracture pattern, your bone quality and your general health. If the break is badly out of place and your bones are thin, or you are over 75, we may discuss replacing part of the hip joint instead of pinning it. We will explain which option suits you and decide together.

Your general health matters as much as the break. We work with your GP and other doctors to manage medical conditions such as heart or lung disease before and after surgery, and we treat thin bones with osteoporosis medicine where that is appropriate. This team approach helps lower the risk of complications and shortens your hospital stay.

A few situations allow other paths. If surgery carries too much risk for you, the break can sometimes be managed without an operation, though this needs careful nursing care and a long period of staying off the leg. Some older fractures that were never treated can still be helped with a smaller, minimally invasive procedure. If earlier surgery has failed, further operations can usually rebuild the hip.

One-year mortality rates after this type of hip fracture are between 10% and 30%. Your age, your health before the injury and how well you were moving beforehand all shape where you land in that range. Prompt surgery and shared care aim to keep those risks down.

What to expect

These fractures usually heal well, because the break sits in a part of the thigh bone with a rich blood supply. Once the pieces are held in place, the bone knits and your hip muscles can start working again. Most people notice the pain settles well before their strength and walking return to normal.

Recovery takes time, and it is honest to say so. Walking ability and everyday tasks such as dressing and bathing often take a clear step backwards after this injury. Some people need a longer stretch of rehabilitation than others, particularly if the break was badly out of place or your general health was already strained. The difference between a smoother and a harder recovery tends to fade over time. Hip pain is usually not the main problem afterwards. The bigger challenge is getting your walking and independence back.

Your overall health shapes your outlook as much as the break itself. Age, heart failure, memory problems, thin bones and low blood protein all influence how the next year goes. If you have several medical conditions at once, recovery is harder and the risks are higher. This is why we treat the whole person, not just the bone.

If the fracture is left alone, the outlook is poor. The broken ends keep sliding out of line under the pull of your hip muscles, and the bone cannot hold your weight. Good results cannot be achieved with traction alone, so a long period off the leg without surgery does not lead to healing in a usable position.

When surgery goes ahead, most fractures unite and the metal stays put. A small number of people need a further operation, and if the first repair fails, the hip can usually be rebuilt with a joint replacement. That second operation is more involved than the first, but the results are generally satisfactory and most implants stay in place for years afterwards.

Set realistic goals. Expect steady progress over weeks and months rather than a quick fix, expect good days and flat days, and expect your care team to keep working with you well after the bone has knitted.

When to see someone

Go to an emergency department straight away if you cannot stand or put weight through your leg after a fall, or if your leg looks shorter or turned outward. These breaks need same-day assessment. Ask for urgent review if you feel washed out or dizzy, which can mean the hip is losing blood inside. See your GP promptly if pain after a fall is not settling, especially if your bones are thin, since some of these cracks barely show on plain X-rays. If you have already had surgery and develop new hip pain, increasing weakness or trouble walking, ask for a specialist review. If you have several medical conditions such as heart failure or memory problems, tell the treating team early, because your general health shapes your recovery as much as the break does.

Reviewed by AI synthesis (v2) — pending human review · 9 September 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 hip is a multiaxial joint formed by the articulation between the pelvis and femur, connecting the axial skeleton and the lower extremity [8].
  • The hemipelvis comprises three bones: the ilium, ischium, and pubis, which unite at the triradiate cartilage within the concave acetabulum [8].
  • The acetabulum comprises an articular crescent-moon-shaped lunate surface and a nonarticular central fossa that serves as the attachment point for the ligamentum teres [8].
  • The femoral head forms two-thirds of a sphere, with a small depression at its center from which the ligamentum teres extends to connect to the acetabular notch [8].
  • The neck-shaft angle of the femur averages 125° [8].
  • Normal version, defined as the head-neck angle in the frontal plane, averages 15 to 20° [8].
  • At the junction of the femoral neck and shaft are the greater and lesser trochanters, connected by the intertrochanteric line anteriorly and the intertrochanteric crest posteriorly [8].
  • The acetabulum is normally anteverted 15 degrees and obliquely oriented in the coronal plane 45 degrees caudally [14].
  • The posterosuperior articular surface of the acetabulum is thickened to accommodate weight bearing [14].
  • The inferior surface of the acetabulum contains the acetabular (cotyloid) notch, which is bound by the transverse acetabular ligament [14].
  • The femoral neck is normally anteverted approximately 14 degrees in relation to the femoral condyles, with a range of 1 to 40 degrees [14].
  • The femoral neck-shaft angle averages 127 degrees, beginning at 141 degrees in the fetus [14].
  • The mean femoral neck-shaft angle in the adult is 130° ± 7° [18].
  • The mean anteversion of the femoral neck is 10° ± 7° [18].
  • The two prime trabecular groups of the proximal femur are the principal tensile group and the principal compressive group [18].
  • Secondary compressive and tensile trabecular groups also exist in the proximal femur [18].
  • The weakest area in the femoral neck is located in the Ward triangle [18].
  • The calcar femorale is a medial area of dense trabecular bone that transfers stress from the femoral shaft to the inferior portion of the femoral neck [18].
  • Fractures of the proximal femur follow the path of least resistance [18].
  • The amount of energy absorbed by the bone determines the degree of comminution in proximal femur fractures [18].

Ligaments and Capsule

  • The hip is surrounded by a dense fibrous capsule extending from the periphery of the acetabulum to the intertrochanteric line of the femoral neck [8].
  • The capsule enhances joint stability by preventing translation of the femoral head in the acetabulum [8].
  • The hip joint capsule extends anteriorly to the intertrochanteric crest but posteriorly only partially across the femoral neck [5].
  • The basicervical and intertrochanteric crest regions are extracapsular [5].
  • The iliofemoral ligament, also known as the Y ligament of Bigelow, is the strongest ligament in the body [5].
  • The iliofemoral ligament attaches from the anterior inferior iliac spine (AIIS) to the intertrochanteric line in an inverted Y manner [5].
  • The iliofemoral ligament functions to limit external rotation, while its lateral arm limits extension of the joint [8].
  • The ischiofemoral ligament extends from the ischial margin of the acetabulum to the greater trochanter of the femur and restricts internal rotation motion [8].
  • The pubofemoral ligament extends from the obturator crest of the pubic bone to the femoral neck and acts to limit abduction of the joint [8].
  • Deep fibers from the iliofemoral, ischiofemoral, and pubofemoral ligaments merge to form the zona orbicularis, which circumvents the femoral neck [8].
  • The hip capsule is attached to the femur anteriorly along the intertrochanteric crest [9].
  • On the posterior side, the hip capsule attaches only partially, such that the basicervical region of the femoral neck and the intertrochanteric region of the femur are not intracapsular [9].
  • The iliofemoral ligament becomes taut in full extension, preventing anterior dislocation and hyperextension of the hip [9].
  • The twisted orientation of the hip ligaments provides a screw mechanism for the hip in full extension [9].
  • The ligamentum teres originates in the cotyloid fossa and attaches on the fovea of the femoral head [9].

Vascular Anatomy

  • The medial femoral circumflex artery is the main blood supply to the femoral head [18].
  • The medial femoral circumflex artery terminates in the posterior aspect of the extracapsular arterial ring [18].
  • The lateral femoral circumflex artery gives rise to the anterior aspect of the extracapsular arterial ring [18].
  • The superior and inferior gluteal arteries contribute branches to the extracapsular arterial ring [18].
  • The ascending cervical arteries originate from the extracapsular arterial ring and are divided into lateral, medial, posterior, and anterior groups based on their anatomic relationship to the femoral neck [18].
  • The lateral group of ascending branches is the main blood supply to the femoral head [18].
  • The ascending branches give off multiple perforator vessels to the femoral neck and terminate in the subsynovial arterial ring located at the margin of the articular surface of the femoral head [18].
  • The lateral epiphyseal artery penetrates the femoral head and is believed to be the dominant blood supply to the femoral head from this system [18].
  • Fractures that disrupt the ascending blood flow to the lateral epiphyseal vessel have an increased risk of osteonecrosis [18].
  • The artery of the ligamentum teres arises from either the obturator or medial femoral circumflex artery [18].
  • The artery of the ligamentum teres does not provide sufficient blood supply to maintain the viability of the femoral head [18].
  • In adulthood, the major blood supply to the femoral head is from the medial femoral circumflex and lateral epiphyseal arteries [21].
  • From birth to approximately 4 years of age, the major blood supply to the femoral head comes from the medial and lateral femoral circumflex arteries, with major contributions from the artery of the ligamentum teres [21].
  • From the age of 4 years to adulthood, the posterosuperior and posteroinferior retinacular arteries from the medial circumflex artery are the major blood supply [21].

Fracture Pathophysiology

  • Intertrochanteric femur fractures account for approximately 50% of all proximal femur fractures [18].
  • Intertrochanteric fractures are considered extracapsular fractures [18].
  • Callus formation is common in intertrochanteric fracture patterns [18].
  • Nonunion is rare in intertrochanteric fractures because of the absence of synovial fluid and the presence of an abundant blood supply [18].
  • Femoral neck fractures are considered intracapsular fractures and are at higher risk of nonunion [18].
  • Because of the absence of a periosteal or extraosseous blood supply, no callus forms during healing of femoral neck fractures [18].
  • Fracture healing in femoral neck fractures occurs by intraosseous bone healing [18].

Investigations

Radiography

  • Conventional radiographs remain critical in the initial imaging evaluation of the hip and can be used to diagnose fractures [2].
  • A complete hip series usually consists of an anterior-posterior (AP) pelvis, a centered AP hip, a lateral view (frog-leg, cross-table, Dunn 45° or 90°), and a false-profile (Lequesne) view [2].
  • Radiographs remain integral to the assessment of fractures and can be supplemented with CT to further investigate suspected occult fractures, define fracture morphology, and assist in preoperative planning [2].
  • Radiographs can serially assess hardware positioning and evaluate symptomatic hardware related to open reduction and internal fixation [2].
  • Plain radiographs are the first imaging studies obtained for patients presenting with hip pain and can determine the presence of fractures, degenerative changes, and abnormal joint morphology [25].
  • Standard AP radiographs of the hip and pelvis are obtained to examine bony architecture, check for evidence of joint space narrowing or changes to bone quality, and quantify femoral head coverage [25].
  • The Dunn view and frog leg view are appropriate to measure the alpha angle to determine the presence of impingement [25].
  • Radiographs are essential in the workup of patients with hip pain and may be used to assess for osteoarthritis, femoroacetabular impingement (FAI), and developmental dysplasia of the hip (DDH) [28].

Computed Tomography

  • CT overcomes the limitations of radiography by providing three-dimensional assessment of bony morphology and, to some degree, assessment of soft-tissue abnormalities [10].
  • CT is helpful in fracture evaluation, particularly in the setting of negative radiographs or for further defining fracture morphology in patients requiring surgical reduction [10].
  • CT scans are effective for examining cortical and cancellous bone and can be used to create three-dimensional reconstructions of the hip for use in surgical planning [25].
  • Measurements of femoral head coverage and acetabular and femoral impingement can be performed reliably using CT images [25].
  • The multiplanar and 3D capabilities of CT make it an invaluable tool for assessing bone morphology, but at higher cost and radiation dose [28].
  • 3D volume renderings are useful to aid in preoperative planning in FAI and subspine impingement [28].

Magnetic Resonance Imaging

  • MRI is the modality of choice for patients suspected of soft tissue or intra-articular pathology, given its superior sensitivity and specificity [25].
  • Conventional MRI is effective at identifying osteochondral injuries, musculotendinous pathologies, and inflammation [25].
  • Magnetic resonance arthrography (MRA) is more appropriate to determine injuries to the labrochondral structures and the ligamentum teres and identify the presence of loose bodies and synovial chondromatosis [25].
  • In the accurate detection and staging of articular cartilage lesions, the utility of MRA is reduced, with sensitivity reported to be less than 50% compared with arthroscopic findings [25].
  • Recent advances in MRI imaging techniques, such as delayed gadolinium-enhanced MR imaging and T2* mapping, allow for a more in-depth analysis of the structure of articular cartilage [25].
  • MRI is useful for the assessment of developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI), as well as for extra-articular pathologies, stress injuries of bone, and hip arthroplasties [28].
  • Noncontrast MRI at 3T is generally adequate for diagnosing intra-articular pathology [28].
  • If 3T imaging is unavailable, MRA can be considered at 1.5T for increased diagnostic accuracy [28].
  • MRI is helpful in identifying femoral neck stress fracture in athletes and predicting patients that may require surgical intervention [28].
  • MRI is helpful in assessing complications of conventional and resurfacing hip arthroplasties, particularly those with metal-on-metal bearing systems [28].
  • Major findings that help predict histologic ALVAL scores include synovial thickening, synovitis, synovial volume, abductor disruption, and soft-tissue edema [28].

Ultrasonography

  • Ultrasonography provides real-time dynamic assessment of the hip and is useful in diagnosing soft-tissue abnormalities about the hip joint [10].
  • Ultrasonography is particularly useful in providing real-time guidance during diagnostic and therapeutic procedures [10].
  • Although ultrasonography is a valuable tool to examine pediatric hip conditions, its utility in evaluating the adult hip is limited [25].
  • Ultrasonography can be an effective modality to identify musculotendinous disruptions, effusions associated with intra-articular pathology, or inflammatory conditions, such as bursitis [25].
  • Ultrasonography is increasingly used for targeted injections into muscles, tendons, or intra-articularly around the hip for use with corticosteroids or biologic treatments [25].
  • Ultrasonography allows bedside evaluation of the hip and can be used to guide interventions in the office setting [28].
  • Ultrasonography cannot image inside bone because bone cortex reflects almost all sound waves [29].
  • Internal joint structures are not well visualized unless they are in a superficial location [29].

General Principles

  • Findings from imaging studies should complement clinical examination findings to provide the most accurate diagnosis [1].
  • A thorough history is essential to differentiating between common causes of hip pain, and clinical examination tests and imaging findings should be used to confirm a suspected clinical diagnosis [1].

Treatment

  • Appropriate identification of associated medical comorbidities, medical and orthopaedic comanagement, and prompt surgical treatment may minimize the risks of complications, morbidity, and mortality while improving outcomes [33].
  • The implant choice should be based on fracture pattern, cost, and the surgeon’s familiarity [33].
  • The goal of implant selection is to deliver patient-appropriate care in a timely manner [33].
  • The use of multidisciplinary teams, which include primary care providers, geriatricians, internists, social workers, physiatrists, and care managers, can help to lower cost by decreasing complications and hospital lengths of stay [33].
  • Stable and unstable fracture patterns of intertrochanteric fractures in the Evans classification are differentiated by presence of posteromedial cortex apposition and lateral wall integrity [33].
  • Outcome after intertrochanteric hip fracture depends on the patient’s preinjury functional levels and medical comorbidities [33].
  • One-year mortality rates after intertrochanteric hip fracture are between 10% and 30% [33].

References

[1] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy and Biomechanics, Evaluation, Clinical Examination, and Imaging of the Hip > Summary.

[2] Orthopaedic Knowledge Update Sports Medicine 6. Imaging of the Hip > Radiography.

[5] Miller S Review Of Orthopaedics. Genetics of musculoskeletal conditions and abnormalities are summarized in Table 1.27 > 2. Arthrology > Hip (Fig. 2.49).

[8] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy and Biomechanics, Evaluation, Clinical Examination, and Imaging of the Hip > Osseous and Ligamentous Anatomy.

[9] Aaos Comprehensive Orthopaedic Review 3. Surgical Anatomy of the Hip > IV. Hip Capsule and Ligaments.

[10] Orthopaedic Knowledge Update Sports Medicine 6. Imaging of the Hip > Introduction.

[14] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > LOWER EXTREMITY.

[18] Aaos Comprehensive Orthopaedic Review 3. Fractures of the Hip > I. General Considerations.

[21] Aaos Comprehensive Orthopaedic Review 3. Surgical Anatomy of the Hip > VI. Neurovascular Structures Surrounding the Hip.

[25] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy and Biomechanics, Evaluation, Clinical Examination, and Imaging of the Hip > Imaging.

[28] Orthopaedic Knowledge Update Sports Medicine 6. Imaging of the Hip > Summary.

[29] Aaos Comprehensive Orthopaedic Review 3. Musculoskeletal Imaging* > IV. Ultrasonography.

[33] Orthopaedic Knowledge Update Trauma. Intertrochanteric Hip Fractures in the Geriatric Population > Summary.

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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.