Este projeto, analisou a distribuição dos neurônios nos plexos mioentérico (PM) e submucoso (PS) imunorreativos aos receptores P2X2 (ir) e P2X7 (ir), calbindina (Calb-ir), calretinina (Calr-ir), colina acetil transferase (ChAT-ir) e ao óxido nítrico sintase (NOS-ir) do colo distal de ratos submetidos à desnutrição a renutrição protéica. Utilizaram-se colos distais de ratos nutridos (N42), desnutridos (D42) e renutridos (RN42). Os resultados do plexo PM, demonstraram que 100% dos neurônios Calb-ir, Calr-ir, ChAT-ir e NOS-ir, expressavam os receptores P2X2-ir e P2X7-ir nos três grupos. A densidade neuronal no PM, demonstrou um aumento de 20% a 97% dos neurônios receptores P2X2-7-ir, Calr-ir, ChAT-ir e NOS-ir e no PS foi de 29% a 75%, ambos D42 e recuperação no RN42. O perfil neuronal P2X7-ir, Calb-ir, Calr-ir e ChAT-ir do PM demonstrou diminuição de 28% a 40% e no PS os neurônios P2X2-7-ir, Calb-ir e ChAT-ir de 19% a 47% no D42. Concluí-se que, a desnutrição afeta os neurônios entéricos havendo recuperação na renutrição, podendo influenciar nas funções gastrintestinais. / The aim of the work was to analyze the distal colon myenteric (MN) and submucous (SN) neurons immunoreactive for P2X2-7 receptors, calbindin (Calb-ir), calretinin (Calr-ir), choline acetyltransferase (ChAT) and nitric oxide synthase (NOS) of the animals submitted to undernutrition and refeeding proteic. Distal colon was used from nourished (N42), undernourished (D42) and refeeding (RN42) rats. The results have shown 100% coexpression of the myenteric and submucous Calb-ir, Calr-ir, ChAt-ir e NOS-ir neurons with P2X2-7-ir receptors. The MN density have shown increase of the 20% and 97% of the P2X2-7-ir, Calr-ir, ChAT-ir e NOS-ir neurons of the D42 group, and the SN have been increased 29% a 75% in the D42 group. In the MN neuronal profile have shown decrease P2X7-ir, Calb-ir, Calr-ir and ChAT-ir neurons of the 28% to 40% and in the PS P2X2-7-ir, Calb-ir and ChAT-ir of the 19% a 47% neurons in the D42 group. I concluded that, the undernutrition affects the enteric neurons and there was recuperation in the refeeding, this can influence the gastrintestinal functions.

A alta frequência das fraturas da extremidade distal do rádio estimula o contínuo estudo e desenvolvimento dos métodos de tratamento, buscando melhor qualidade de vida com menos sequelas e limitações. A placa volar bloqueada tem se tornado o método de escolha no tratamento nos últimos anos. Menos morbidade e a reabilitação mais precoce têm aumentado muito a utilização dessas placas. Esse método, contudo, não é isento de complicações. As mais frequentes estão relacionadas aos tendões extensores. Tendinites e rupturas têm sido relatadas. Com o objetivo de se proteger os tendões extensores, estudos têm sugerido a utilização de parafusos unicorticais na parte distal da placa e recomendam que os mesmos tenham pelo menos 75% do comprimento do parafuso bicortical. Esses estudos são restritos a fraturas extra-articulares. Esta pesquisa objetivou estudar e comparar as propriedades mecânicas dos modelos fixados com placas volares utilizando parafusos unicorticais e bicorticais em fraturas intra-articulares da extremidade distal do rádio classificadas como AO 23C3 sob cargas fisiológicas e a possibilidade de recomendar o parafuso unicortical na prática clínica. Objetivou também comparar, pelo método dos elementos finitos, as tensões geradas nos modelos após diferentes carregamentos com validações realizadas com os resultados dos ensaios mecânicos. Foram avaliados 42 modelos divididos em seis grupos de sete modelos, três com parafusos unicorticais e três com parafusos bicorticais. Cada grupo foi submetido a um único tipo de ensaio: compressão axial, flexão dorsal e flexão volar. Foram feitos dois ensaios estáticos intercalados por um carregamento cíclico e por último um ensaio até a falência. Os resultados demonstraram similaridade entre os respectivos grupos e confirmaram nossas hipóteses de que: a) o comportamento mecânico do modelo utilizando parafusos unicorticais é equivalente ao modelo usando parafusos bicorticais; b) o carregamento cíclico afeta o comportamento mecânico dos modelos das fixações das placas volares bloqueadas na extremidade distal do rádio. A análise por elementos finitos mostrou que as fixações unicortical e bicortical não resultaram em qualquer região de concentração de tensão crítica, sendo as duas indicadas para a estabilização de fraturas do rádio. / The high frequency of distal radius fractures stimulates the continuous study and development of treatment methods seeking a better quality of life and fewer sequels and limitations. The volar locking plate has become the chosen method for the treatment in recent years. The lower morbidity and earlier rehabilitation have greatly increased the use of these plates. This method, however, is not free from complications, the most common being related to extensor tendons. Tendinitis and rupture have been reported. In order to protect the extensor tendons, studies have suggested the use of unicortical screws in the distal part of the plate, and recommended that they be at least 75% of the length of the bicortical screw. These studies are restricted to extra articular fractures. This study aimed at studying and comparing the mechanical properties of the models fixed with volar plates using unicortical and bicortical screws in intra-articular fractures of the distal radius classified as AO 23C3 under physiological loads and the possibility of recommending the unicortical screw in clinical practice. The tensions generated in the models after different loads with validations performed with the results of the mechanical tests were also compared. We studied 42 models divided into six groups of seven models, three with unicortical screws and three with bicortical screws. Each group underwent a single type of test: axial compression, dorsiflexion and volar flexion. Two static tests were performed, intercalated by a cyclic loading, and finally a test until bankruptcy. Our results demonstrated a similarity between the respective groups and confirmed both our hypotheses that: a) the mechanical behavior of the model using unicortical screws is equivalent to the model using bicortical screws, and b) that the cyclic loading affects the mechanical behavior of the models of the fixations of the volar locked plates in the distal radius. The finite element analysis showed that the unicortical and bicortical fixations did not result in any regions of critical stress concentration, so they are both indicated for the stabilization of radius fractures.

Les fractures de fragilité représentent un problème de santé publique pour les personnes âgées. L'évaluation de la résistance osseuse et du risque de fracture par la méthode de référence (absorption bi-photonique à rayons X, DXA) est limitée. Les micro-modèles en éléments finis (µFEM) ont montré de meilleures prédictions de la résistance osseuse, mais on ne peut confirmer qu’ils améliorent l’estimation du risque de fracture par rapport à la DXA. L'objectif de cette thèse était donc d'évaluer si la prédiction par simulation numérique pouvait être améliorée en prenant en compte des conditions réalistes de chargement. Tout d’abord, les conditions de chargement correspondant à une chute vers l’avant ont été reproduites sur 32 radius humain dans une expérimentation ex-vivo. Les résultats expérimentaux ont conduits à deux groupes : un fracturé et un non fracturé. Puis, la capacité de prédiction d’un modèle « ségment » (9 mm de radius distal) créé en utilisant un scanner à très haute résolution (High Resolution peripheral Quantitative Computed Tomography) a été évaluée. . Différentes configurations (axiale (configuration standard) et 5 non-axiales) ont été simulées. L’implémentation de chargement non-axial n’a pas amélioré la capacité de prédiction du modèle « segment ». Finalement, un modèle hétérogène du radius distal entier a été créé à partir d’un scanner clinique (Cone Beam Computed Tomography). Ce modèle a pris en compte les conditions d’une chute en termes d’orientation et de vitesse. Le modèle de radius distal entier a montré une meilleure prédiction de la charge à la rupture expérimentale que le modèle « segment ». Cette étude propose des données originales pour la validation de modèles numériques pour l’amélioration de la prédiction du risque de fracture / Fragility fractures represent a public health problem for elderly. The assessment of the bone strength and of the risk of fracture by the gold standard method (Dual X-ray Absorptiometry - DXA) is limited. Micro-finite element models (µFEM) have shown to better predict the bone strength, but it is not possible to confirm that they do better than the density measured by DXA to estimate the risk of fracture. Thus, the aim of this thesis was to evaluate whether including realistic loading conditions could improve the level of prediction of the FEM. First, we reproduced the loading conditions of a forward fall on 32 radii in an ex-vivo experiment. This experiment leaded to two groups: one fractured and one non - fractured. Then, we evaluated the prediction capability of a segment FEM (9 mm of the distal radius) created using the High Resolution peripheral Quantitative Computed Tomography. This segment FEM was tested under the axial loading (standard analysis), and under five additional non-axial configurations. It was found that the prediction capability of the segment FEM was not improved by the implementation of non-axial loadings. Finally, a heterogeneous FEM of the whole distal radius was created using data from a Cone Beam Computed Tomography. This model considers the fall loading configurations in orientation and speed of the ex-vivo experiment. The FEM of the whole distal radius has a better accuracy to predict the experimental failure load than the segment FEM. This study proposes original data for model validation dedicated to further improvements of fracture risk prediction

Syftet med studien var att utvärdera patientens upplevelse av den postoperativa smärtan och behandlingen av denna när den perifera nervblockadens effekt avtagit efter operation av distal radiusfraktur. Metoden som använts är en empirisk kvantitativ deskriptiv enkätstudie. Tjugo patienter deltog i denna pilotstudie. Demografin stämde väl överens med de statistiska data, som visar att distrala radiusfrakturer är vanligt förekommande hos kvinnor i åldern 55 år och äldre. Resultatet av studien har påvisat att många patienter har upplevt mer smärta än vad de själva varit beredda på. Slutsatsen utifrån visuell analog skala, VAS, visar att smärtan har varit svår för patienterna att behandla hemma trots att de haft tillgång till smärtbehandlade läkemedel. Informationen som patienten erhållit har varit otillräcklig och kan vara en källa till den svårbemästrade smärtan. / The aim of the study was to evaluate patient´s experience of the postoperative pain and its treatment after peripheral nerve blockade for operation of a distal radius fracture had ceased. The method used was an empiric, quantitative, descriptive study using enquiries. Twenty patients participated in this pilot study. Demography was according to statistical data, that distal radius fractures are common in women aged 55 or more. The results showed that many patients experienced more severe pain than expected. The conclusion from visual analogue scale, VAS, shows that the pain was difficult to treat at home in spite of prescription of pain killers. The information given to the patient was insufficient, which may have contributed to the difficulty to control pain.

Introduction: The forearm is a complex biological unit, which has allowed man's evolution. This PhD commenced with an analysis of the normal biomechanical functioning of the key components of the forearm: notably the distal radioulnar joint (DRUJ), interosseous ligament (IOL) and proximal radioulnar joint (PRUJ). Understanding normal forearm physiology, a clinical study followed to delineate the pathophysiology of a new clinical entity, related to DRUJ dysfunction. Methods: Biomechanical Study: A biomechanical testing jig was developed to facilitate collection of data about normal functioning of the DRUJ, IOL and PRUJ in both unloaded and loaded states. This permitted testing throughout the range of forearm pronosupination. Thawed fresh frozen cadaveric upperlimbs were mounted into the jig. Using Microstrain® strain gauges and Tekscan™ pressure sensors, the functional anatomy of the key components of the forearm was delineated, both with the forearm flexed at 90° and maximally extended at the elbow. Clinical Study: A series of 3-Tesla MRI scans was undertaken on patients symptomatic of an intermittent ulnar neuropathy. The causative pathophysiology was determined using 3D qualitative and quantitative analyses. Results: Biomechanical Study: Reproducible patterns of force transmitted and joint contact area have been determined for the DRUJ, and for the first time, the PRUJ. With the exception of PMax and P60 for the PRUJ, application of load increases contact areas and transmitted forces across the joints (P<0.05). The converse is true for PMax and P60 in the PRUJ. The IOL is lax during pronation, strain gradually increasing as the arm moves to neutral. In neutral the middle-portion of the IOL (m-IOL) demonstrates most strain, this decreasing again in supination, whilst the distal and proximal portions (d- & p-IOL) exhibit more strain (P<0.05). Axial loading consistently increases strain in all ligaments (P<0.05). Observed behaviour patterns across the joints and in the ligaments alter with elbow extension (P<0.05). Clinical Study: Salient symptoms of the new syndrome were described. Displacement of the ulnar nerve from its normal course was seen with compression/distraction in the distal forearm and Guyon’s canal. This was considered causative of the syndrome. As a by-product of the research, a new clinical device was also developed, which improves the patient pathway when investigating DRUJ dysfunction. Conclusions and Outcomes: This research has analysed normal forearm biomechanics determining that the PRUJ is a load-bearing joint, interrelated with the DRUJ and IOL. Elbow extension has been shown to alter the normal biomechanics of the forearm. A clinical entity of a dysfunctional forearm has been defined, called subluxation-related ulnar neuropathy or SUN syndrome. Finally, a new clinical device has been developed, which it is anticipated will translate into visible improvements in patient care.

Bakgrund: Distal radiusfraktur är den vanligaste frakturen i Sverige där kvinnor drab-bas oftare än män. Majoriteten av de patienter som opereras vårdas på en dagkirurgisk enhet och sköter sin egenvård i hemmet. Kvinnor upplever smärta annorlunda än män vilket kan ha betydelse i valet av smärtlindringsstrategi. Inför operationen erhåller patienten antingen en plexusblockad eller generell anestesi med infiltrationsanestesi i smärtlindrande syfte. I anestesisjuksköterskans kompetensbeskrivning ingår det att ansvara för planering och övervakning vid dessa olika anestesimetoder. Vilken av de två anestesimetoder som används varierar på sjukhusen runt om i Sverige. Det finns ett begränsat forskningsunderlag på vilken anestesimetod som är att föredra. Syfte: Syftet var att undersöka smärtupplevelsen hos kvinnor efter dagkirurgisk operation av distal radiusfraktur. En jämförelse mellan anestesimetoderna plexusblockad och infiltrationsanestesi med Ropivacain. Metod: En kvantitativ enkätundersökning. Data har samlats in genom ett bekvämlighetsurval där enkäten bestående av strukturerade frågor har delats ut av personal på sju postoperativa avdelningar. Resultat: Inga statistiskt signifikanta skillnader har hittats mellan grupperna som erhållit antingen plexusblockad eller infiltrationsanestesi med Ropivacain. Dock visade sig en betydande andel uppleva svår eller värsta tänkbara smärta kvällen eller natten efter operation. Båda grupperna uppvisar även problem med sömn och vila postoperativt. Slutsatser: Resultatet från magisteruppsatsen antyder att det finns förbättringspotential postoperativt för kvinnor med radiusfraktur som upplever smärta. Dessutom bör grundläggande behov, särskilt vila, sömn och aptit, tas i beaktande. / Background: Distal radius fracture is the most common fracture in Sweden and women are affected more often than men. The majority of the patients who require surgery are cared for in a day surgery unit. They are then responsible for their own care at home. Women experience pain differently than men and this can be important when deciding upon a pain relief strategy. Prior to surgery, the patient receives either a plexus blockade or general anesthesia with infiltration anesthesia for pain relief purposes. The nurse anesthetist´s (CRNA) competence description includes being responsible for planning and monitoring of these different anesthesia methods. The choice of anesthesia method used varies in hospitals around Sweden. There is a limited amount of research on which anesthesia method is preferable. Method: A quantitative survey. Data has been collected using convenience sampling where a questionnaire consisting of structured questions was distributed by hospital staff in seven postoperative departments. Results: No statistically significant differences were found between the groups that received either plexus block or ropivacaine infiltration anesthesia. However, a significant proportion were found to experience either severe pain or the worst possible pain in the evening or night after surgery. Both groups show problems with sleep and rest postoperatively, while the infiltration group tends to be more inconvenienced by decreased appetite than the patients in the plexus group. Conclusions: The results of the master's thesis suggest that there is potential for improvement for postoperative female patients with a radius fracture experiencing pain. Additionally basic needs, in particular rest, sleep and appetite, should be taken into account.

Malkostrake Krebse zeigen im postnauplialen Keimstreif ein invariantes Zellteilungsmuster und eine Zelllinie. Embryonen eines Isopoden (Porcellio scaber) und eines Amphipoden (Orchestia cavimana) wurden bezüglich ihrer Zelllinie vergleichend Untersucht. Mittels immunhistochemischer Färbungen wurde das Expressionsmuster der Gene engrailed und Distal-less in Hinblick auf die Zelllinie und die Morphogenese der Segmente und der Beinentwicklung analysiert. Die Zelllinie wurde bei Porcellio scaber mit der Methode der 4D-Mikroskopie untersucht. Mit Zellablationsexperimenten wurden Abhängigkeiten der Zellen untereinander aufgezeigt. Die Ergebnisse dieser Untersuchungen zeigen: I. Die Genexpression von Distal-less und engrailed wird unabhängig von der Zelllinie reguliert. II. Die Bildung der konvergenten einästigen Beine im Thoraxbereich beider Krebse erfolgt durch unterschiedliche Regulation des Gens Distal-less - bei Orchestia cavimana wird die Expression des Gens in den lateralen Zellen abgeschaltet, während diese Zellen bei Porcellio scaber erst gar nicht Distal-less exprimieren. III. Die Anwendung des Systems der 4D-Mikroskopie zeigte unter anderem, dass in den vorderen Reihen nichtektoteloblastischen Ursprungs bei Porcellio scaber die Zelllinie variabel ist und eine Zellsortierung und Zellimmigration stattfindet. IV. Die Ähnlichkeit der Bildung dieser Reihen bei Porcellio scaber mit der der Tanaidaceen lässt auf ein Schwestergruppenverhältnis der Taxa Isopoda und Tanaidacea schliessen. Die Dissertation enthält fünf Videoaufnahmen als separate AVI-Dateien. / Malacostracan crustaceans show in their postnaupliar germ-band an invariant cleavage pattern and a cell-lineage. A comparative analysis of this cell-lineage in an Isopod (Porcellio scaber) and an amphipod (Orchestia cavimana) was done in this thesis. Immunohistochemical stainings of the gene products Distal-less and Engrailed were used, to show the relation of these genes to the morphogenesis of segments and legs. Further, the cell-lineage of Porcellio scaber was analyzed with a 4D-microscope system. Cell-ablation experiments were used to show regulational networks in the development of the germ-band. The results of this work show: I. The regulation of the genes Distal-less and engrailed is independent of the cell-lineage. II. The morphogenesis of the convergent monoramous limbs in the thorax is reflected by different expression patterns of the gene Distal-less - in Orchestia cavimana the expression of Distal-less is switched off in the lateral cells, in Porcellio scaber these cells do not start the Distal-less expression. III. The 4D-microscopy analysis show, that the cell-lineage in the cellrows wich have a non-ectoteloblastic origin is not invariant. In these rows of cells show cell sorting. IV. The formation of these rows in the isopod Porcellio scaber shows similarity to the formation in tanaidaceans. A sister group relationship of Tanaidacea and Isopoda is strongly supported. This dissertation contains five video recordings as separate AVI files.

Distal radius fracture (DRF) is the most common fracture encountered in clinical practice. Every year, more than 20000 people in Sweden suffer from this injury. It has been shown that there is a correlation between malalignment and function following distal radial fractures and malunion may cause persistent pain and disability. A problem has been in making a correct initial assessment of the fracture. Many fractures are unstable despite an acceptable position on the initial radiographic examination or following a successful closed fracture reduction. Numerous classification systems have been developed for evaluation of DRF in order to predict the outcome. However, the values of these are limited since they have not shown satisfactory reliability. Furthermore, the utility of these systems to predict radiographic or clinical outcome is not yet proven. These shortcomings may be one reason why optimal DRF management is still controversial. Requests for a new classification system of DRF, predictive of outcome and easy to use, have been made. Improvement in initial assessment of DRF will benefit a large group of patients, as well as the society, by reducing persistent symptoms and disability. Study I: In this study we evaluated the interobserver and intraobserver reliability of a new classification system (the Buttazzoni classification). Two hundred and thirty-two patients with acute DRF were blindly evaluated using the new classification by three orthopaedic surgeons twice with a 1-year interval. The new classification showed fair to substantial interobserver and intraobserver reliability, i.e., results comparable with other commonly used classification systems. Study II: This was a prospective multicenter study of fracture stability in 428 DRF. The study investigated whether cortical comminution and intra-articular involvement, as well as the new classification system, could predict displacement in DRF. Logistic regression analysis showed that initial position of the fracture and volar or dorsal comminution predicted later displacement, while intra-articular involvement did not. Volar comminution was the strongest predictor of displacement. The new classification system, which is the first to include volar comminution as a separate parameter, was highly predictive of fracture instability. Furthermore we found that it is quite common for non-operatively treated fractures to displace at a later stage than two weeks. Study IV: In study II it was found that late displacement of DRF, still in acceptable radiologic position after 10-14 days, occurred in approximately 1/3 of cases. Despite this, we have not been able to find any study focusing on evaluating the clinical outcome in patients with late displacement. Two hundred and nine unilateral DRF from study II were still in good position after 10-14 days and were included in the study. One hundred and seventy five patients had radiographs taken at a minimum of 3 months and a clinical examination 1 year after the fracture. Late displaced distal radius fractures had significantly higher loss of ROM and grip strength compared to fractures that didn’t displace. No significant differences were seen in subjective outcome. In conclusion, initial position of the fracture predicted later displacement and was the most important parameter in predicting clinical outcome. Comminution of the fracture also affected radiological stability and clinical outcome. Volar comminuted fractures are highly unstable and need surgical intervention if displacement is to be avoided. Intra-articular involvement affected clinical outcome. Late displacement is common in DRF and may result in loss of range of motion and grip strength. To detect late displacement, DRF should be followed for more than 2 weeks. The new classification system had a moderate reliability and reproducibility. The classification was found predictive of radiologic and objective clinical outcome. However, it was not predictive of subjective outcome. The classification system was also predictive of fractures at risk for late displacement.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Background Running is a popular form of exercise that more than 55 million Americans actively participate. Endurance running like marathon and half- marathon is getting increasingly popular among active runners. Although the effect of running is considered beneficial to bone health, the direct relationship between strains and strain gradients occurred during long distance running and bone changes is still not clear. Especially, given a high rate of injury associated with the first-time marathon, understanding the direct effect of strain stimuli on bone health is an important issue. Based on the previous studies, we hypothesized that the higher values of strain will induce bone adaptation more effectively and will lead to higher bone osteogenic changes. Since osteocytes sense shear stress caused by the interstitial fluid flow, which is created by the deformations, and regulate activities of osteoblasts and osteoclast that govern bone adaptation, we also hypothesized that the local strain gradient will create pressure differences within the interstitial fluid network and will increase fluid flow. Furthermore, due to that increased fluid flow, the regions with the higher strain gradient will experience a higher amount of bone adaptation. Thus, in this study, our purpose was to define the effect of the strains and strain gradients on bone changes within distal tibia, which is the most prone anatomical site to low risk stress fracture, during training for first-time marathon. Methods High-resolution and low-resolution computed tomographic (CT) images of the distal tibia were obtained before and after a self-selected training from runners who were actively training to participate in their first-time marathon in the next calendar year. The low resolution scan covered a 69.864 mm length of the distal end of the tibia while the high resolution CT scan covered a 9.02 mm region of the distal tibia. Using low resolution CT image based subject specific finite element (FE) models, the strains and strain gradients of the distal tibia at the instance of the peak ground reaction force (GRF) were calculated. The baseline and follow-up high resolution CT scans were used in high resolution peripheral quantitative CT (HRpQCT) analysis and the estimation of bone changes over the training period. Finally, the effect of strains and strain gradients on the distal tibia bone changes was estimated based on the FE model driven strain values and HRpQCT analysis driven bone changes. We used a linear mixed model to define the relationship between strain values and bone changes in the distal tibia. Results The strain values that occurred during marathon training had significant effects on bone changes in the distal tibia. Particularly, the strain gradients showed a higher effect than the strains. In the cortical compartment, the strain gradients, which were calculated as a strain difference of a node from the surrounding nodes (Strain Gradient-1), affected the bone mineral density (BMD) negatively, and per 1000 µε increase resulted in 2.123% decrease in the cortical BMD. The strain gradients, which were calculated as a strain difference of a node from the surrounding nodes normalized to distance to surrounding nodes (Strain Gradient-2), presented a positive effect on the cortical bone volume with a slope of 4.335% / 1000 µε. In the trabecular compartment, the strain gradient-1 showed negative effects on the percent change in BMD and bone mineral density (BMC), whereas the strain gradient-2 showed positive effects on the percent change in BMD and BMC. Conclusion The linear mixed model analysis revealed a statistically significant (p < 0.05) relationship between strain gradients that occurred during running and distal tibia bone changes. The strains, biometrics, and initial parameters of bone did not show any significant effect on the bone changes. The connection between local strain environment and bone changes in the distal tibia investigated in this study is an important step to understand the mechanism of mechanically induced bone adaptation.