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Worldwide, every year 1.35 million people die due to road traffic injuries (Global Traffic Safety Report 2018). Road traffic injuries are now the leading cause of death for children and young people (5-29 years old), as reported by the World Health Organisation (WHO). The ‘Decade of Action’ for road safety (2011-2020) was a universal start to save millions of lives by taking a multi-disciplinary collaboration approach for road safety management. It encouraged countries to have safe road infrastructures, safe vehicles, safety-enhanced user behavior and improved road-injury related health services. All countries were encouraged to join this movement to achieve Sustainable Development Goals (SDGs). The ‘Safe Community’ program is a framework to employ local resources and public participation to improve the community safety and the empowerment of the population which will lead to SDGs. So, there is great potential for local communities to improve the safety of their people. Now, in the last year of the Decade of Action for road safety, we have an opportunity to review our achievements, strengths and weaknesses, and future needs so we can develop an action plan for the second decade that will be more equitable and evidence-based considering the local characteristics. The 24th International Conference on Safe Community gathers us to discuss and share our experiences and scientific achievements. Sharing and learning from other safe communities about road safety improvements provides a great example for local communities to employ a bottom-up approach to prevent road trauma due to road traffic injuries.

The definition of peri-prosthetic joint infection (PJI) has a strong impact on the diagnostic pathway and on treatment decisions. In the last decade, at least five different definitions of peri-prosthetic joint infection (PJI) have been proposed, each one with intrinsic limitations. In order to move a step forward, the World Association against Infection in Orthopedics and Trauma (W.A.I.O.T.) has studied a possible alternative solution, based on three parameters: 1. the relative ability of each diagnostic test or procedure to Rule OUT and/or to Rule IN a PJI; 2. the clinical presentation; 3. the distinction between pre/intra-operative findings and post-operative confirmation. According to the WAIOT definition, any positive Rule IN test (a test with a specificity > 90%) scores +1, while a negative Rule OUT test (a test with a sensitivity > 90%) scores −1. When a minimum of two Rule IN and two Rule OUT tests are performed in a given patient, the balance between positive and negative tests, interpreted in the light of the clinical presentation and of the post-operative findings, allows to identify five different conditions: High-Grade PJI (score ≥ 1), Low-Grade PJI (≥0), Biofilm-related implant malfunction, Contamination and No infection (all scoring < 0). The proposed definition leaves the physician free to choose among different tests with similar sensitivity or specificity, on the basis of medical, logistical and economic considerations, while novel tests or diagnostic procedures can be implemented in the definition at any time, provided that they meet the required sensitivity and/or specificity thresholds. Key procedures to confirm or to exclude the diagnosis of PJI remain post-operative histological and microbiological analysis; in this regard, given the biofilm-related nature of PJI, microbiological investigations should be conducted with proper sampling, closed transport systems, antibiofilm processing of tissue samples and explanted biomaterials, and prolonged cultures. The proposed WAIOT definition is the result of an international, multidisciplinary effort. Next step will be a large scale, multicenter clinical validation trial.

Up to 1970 the number of traffic fatalities was rising from year to year. The burden for families as well as for the society was tremendous. Therefore, a strong movement was started within our society, to stop this deadly war on our streets. The government published laws: Speed limit in town and outside, seatbelts obligatory for all passengers, airbags in all cars, alcohol restriction, and mandatory helmets for motorcyclist and etc. Law enforcement was implemented and executed by trained traffic police. The car industry detected, that safety is a marketing tool to sell cars in Germany as well as in other countries. Research programs were started to develop the most effective safety standard, which was then passed into law in Germany and the European Union. The ADAC a NGO (German Automobile Club) started a SAR Helicopter Service, today flying overall in Germany. The SAR helicopter are linked to the EMS on ground. For an effective medical treatment the trauma hospitals work together in a Trauma Network, which is organized and certified by the German Trauma Society a NGO (DGU). The data for the Trauma Network are generated by the Trauma Register of the DGU, which collects specific data since 1993. Children in the schools were trained by specialized police officers to travel safely on all streets. Television shows safety warning and injury prevention clips at the best sending time. Most accidents occur due to human errors. To canalize the human factor, a mosaic of activities must be implemented over a long time. The people must understand and well accept the necessary safety procedures. With the help of all citizen we are able to reduce the burden of traffic accidents and with a sophisticated technology, zero traffic fatalities might be possible in the future. Keywords: Road Safety, Human Errors, Injury

Trochanteric femoral fractures are frequently associated with severe osteoporosis in elderly patients. The failure of devices intended to repair trochanteric fractures, such as the gamma locking nail (GLN), might be related to reduced bone desity. Osteoporosis may also influence pain and walking ability because of low stability in the fracture area. In 74 patients (mean age 76 ± 16.5 years), the stability and clinical outcome following treatment with GLN were prospectively evaluated and recorded after 9 (n = 43) and 24 months (n = 34). Vertebral bone mineral density (BMD) was measured via quantitative computed tomography (QCT) at time of operation. Mechanical failure of GLN was recorded by radiographs of the hip. Assessment of outcome included the Harris Hip Score. Regression analysis was done to show the influence of age and BMD on clinical outcome. 9 months after treatment, complete fracture healing without dislocation of the lag screw of the GLN was observed even in patients with low BMD (< 55 mg/cm3 trabecular BMD). Clinical outcome assessed by the Harris Hip Score was independent of BMD at both follow-ups. At the first follow-up, outcome depended on the patient's age, with younger patients (< 70 years) showing better results than elderly patients. The stability of fracture also seemed to influence the outcome. Our results indicate that stabilization of unstable osteoporotic fractures with GLN is associated with few complications and can be accomplished with identical clinical and radiologic results seen in patients with high BMD. The critical factor influencing outcome is patient's age, stability of fracture and not BMD.

This biomechanical study compares the initial fixation strength of a novel bioabsorbable two-shell expansion bolt (EB) with that of a well-established interference-screw technique in bone-patellar tendon-bone (BPTB) reconstruction in a calf model. Thirty tibia plateaus (age 5-6 months) were assigned to three groups: In groups I and II, trapezoidal bone plugs of BPTB grafts were fixed with bioabsorbable poly-L-lactide interference screws (8 x 23 mm) or titanium interference screws (8 x 25 mm) respectively. In group III, semicircular grafts were fixed using bioabsorbable poly-D, L-lactide expansion bolts (5.8/8.7 x 10 x 35 mm). The tensile axis was parallel to the bone tunnel, and the construction was loaded until failure applying a displacement rate of 1 mm per second. In group II the mean ultimate loads to failure (713 N+/-218 N) were found to be significantly higher than those of groups I (487 N+/-205 N) and III (510 N+/-133 N). Measurement of stiffness showed 45 N/mm+/-13.3 in group I, 58 N/mm+/-17.4 in group II and 46 N/mm+/-6.9 in group III, and did not demonstrate significant differences. We found a correlation between insertion torque and wedge insertion force and ultimate loads to failure in all groups (r=0.53 in group I, r =0.54 in group II, and r =0.57 in group III). Cross-section planes of bone tunnel increased by 51%, 30% and 31% respectively, following insertion of screws or expansion of bolts (p0.05). We conclude that ACL graft fixation by means of the presented expansion bolt demonstrates a fixation strength similar to the established bioabsorbable screw fixation, and is a reasonable alternative fixation method, especially since some of the specific pitfalls of screw fixation can be avoided.