Evaluation of Referral Patterns for Orthopaedic Emergencies from Primary to Tertiary Care in Anambra State

Efficient referral of orthopaedic emergencies from primary health facilities to tertiary centres is a critical component of the trauma care system, yet dysfunctional referral pathways contribute to delayed definitive treatment and poor outcomes in Nigeria. This mixed-methods study evaluates the patterns, determinants, and quality of orthopaedic emergency referrals from primary health care facilities to Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, and Anambra State University Teaching Hospital (ANSUTH), Awka, South East Nigeria, over a six-month period. Quantitative data will be extracted from hospital admission records on referral source, reason for referral, accompanying documentation quality, patient haemodynamic stability at arrival, and time from injury to tertiary care. Qualitative interviews with referring primary care doctors and receiving orthopaedic officers will explore barriers and enablers. Mixed methods analysis will triangulate findings. Delays attributed to inadequate primary stabilisation, absent referral letters, and transport failures are expected to be common. Findings will be submitted to the Anambra State Ministry of Health to strengthen the statewide referral system and introduce standardised orthopaedic emergency referral protocols. This research fills an important gap in trauma systems research in South East Nigeria, contributing evidence toward a more coordinated and effective emergency orthopaedic care continuum. Keywords: referral patterns, orthopaedic emergencies, trauma systems, Anambra, primary health care.