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Timely treatment of pediatric orthopaedic emergencies at level I trauma centers is frequently dependent on transfers from neighboring centers.Records were collected from our level I trauma center for patients with isolated orthopaedic issues accepted for transfer in 2015. Open fractures, compartment syndrome, septic arthritis, and supracondylar humerus fractures with ecchymosis or neurovascular compromise were emergent. The rush hour was 6 AM to 10 AM and 3 PM to 7 PM.Ninety-six patients met the inclusion criteria; 19% (18/96) were orthopaedic emergencies and 37% (35/96) occurred during the rush hour. The average time from transfer acceptance to accepting hospital admission was 203 minutes (range, 68 to 584 minutes; SD, 85.8 minutes). The average time from transfer acceptance to departure from the transferring facility was 114 minutes (range, 7 to 391 minutes; SD, 71.9 minutes). There was no correlation between the transfer time and rush hour (P = 0.40), emergent versus nonemergent (P = 0.42), or routed distance from the hospital (P = 0.46).The average transfer time exceeded 3 hours and was independent of the distance, the rush hour, or urgency of patient condition. An average 2-hour delay was encountered for patients while leaving a medical facility after acceptance of transfer.