In low and middle-income countries, country specific data is scarce regarding the burden of surgical disease, with most estimates extrapolated from indirect methods. Kilimanjaro Christian Medical Center (KCMC) is the only tertiary referral hospital for a population of over 11 million in Northern Tanzania. This study aims to directly quantify the current orthopaedic burden of disease at KCMC and provide a foundation to estimate the magnitude and potential benefit of improving access to

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... c surgical care in the northern regions of Tanzania. Methods: Prospective data was collected during June 2015 for 113 patients admitted to the Orthopaedic Surgery ward at KCMC. Retrospective review of available hospital records for 11,678 patients presenting to the KCMC Emergency Medicine Department, Orthopaedic Clinic, and Orthopaedic Ward over the previous 12 months was also performed to obtain a more complete picture of the burden of orthopaedic disease seen at this tertiary referral center. Results: KCMC treats an average of 11,172 orthopaedic patients each year. Approximately 57.1% of these patients are seen as outpatients in clinic, 30.1% are seen in the emergency department and 12.8% are admitted as inpatients in the orthopaedic ward. Road traffic accidents (RTAs) represented the most common etiology of injury requiring ward admission at 63.7%, followed by falls at 29.2%, and assaults at 4.4%. Of admissions between ages 15-45, 73.5% were from RTAs. The majority of RTAs, 52.8%, involved a motorcycle and 30.56% involved pedestrians. Femur fractures were the most common injury seen (39.0%), followed by tibia (27.2%) and radius (17.7%) fractures. Patients used a wide variety of transportation methods and took 2.3 hours on average to arrive at KCMC from the location of their injury. Once in the hospital, patients averaged a length to surgery of 10.2 days and a hospital length of stay of 13.5 days. Of all admissions, 96.5% had indications for surgical fixation, while only 57.9% received surgery. KCMC is the only tertiary referral center for a five state region; however, 65.7% of patients originated from the same state in which the hospital resides. Conclusions: KCMC sees an approximately identical volume of surgical orthopaedic trauma as a Level 1 Trauma Center in the United States, but has significantly fewer material and intellectual resources to meet this surgical burden. These data give a more complete picture of the patient demographics, mechanisms of injury, types of injury and patient outcomes for similar resource-limited locations.