The authors performed a large, multi-centre prospective observational study in low- and middle-income countries (LMICs). All adults presenting with a fracture or dislocation of the appendicular skeleton and spine were included. The study was performed across 49 hospitals in 18 countries in five different regions of Asia and Africa. Delays to admission were considered to be >2 hours for open fractures and >24 hours for closed fractures. Over 30,000 patients were included, and it was found that delays in admission were very common for open fractures, and less common though still quite prevalent for closed fractures. Overall, this study reveals that fracture care continues to be sub-standard in LMICs and resources are necessary to help resolve this issue.