Pouramin P, Li CS, Busse JW, et al. - Researchers conducted the largest prospective observational study to date examining delays in hospital admission among orthopedic fracture patients. Further, they applied the Lancet Commission on Global Surgery's Three Delays framework, categorizing delays in accessing timely surgical care into delays in seeking care (First Delay), reaching care (Second Delay), and receiving care (Third Delay), to determine the main reasons for these delays in low-income and middle-income countries. They conducted a prospective observational substudy of the ongoing International Orthopaedic Multicenter Study in Fracture Care (INORMUS), including cases with fracture across 49 hospitals in 18 low-income and middle-income countries, categorized into the regions of China, Africa, India, south and east Asia, and Latin America. They defined delays for cases with open fractures as being more than 2 h from the time of injury (in accordance with the Lancet Commission on Global Surgery) and for those with closed fractures as being a delay of more than 24 h. Among 31,255 patients with fractures [median age: 45 years; 19,937 (63·8%) men], lower limb fractures were reported in 14,524 (46·5%) patients, making them the most common fractures. Per observations, timely hospital admission remains largely inaccessible in low-income and middle-income countries; this is particularly evident among patients with open fractures. The most common reason for delays were interfacility referrals and Third Delays among patients delayed by more than 24 h. In comparison with other methods of transportation (eg, walking, rickshaw), ambulances resulted in delay in transporting patients with open fractures to a treating hospital. Delays of more than 24 h before admission to hospital were more frequent among patients with closed spine and pelvic fractures when compared with patients with closed lower limb fractures. Decreasing hospital-based delays in receiving care, and, in particular, improving interfacility referral systems are identified to be the most relevant tools for lowering delays in admissions to hospital.