Background Early surgery seeks to decrease peri-operative complication rates and mean hospital stay lengths while also improving patient satisfaction. Few data exist on optimising care before orthopaedic and trauma surgery (OTS), notably regarding delays to surgery after admission. The objective of this study was to identify reasons for OTS delays at a university-hospital OTS centre in France. Surgery was defined as delayed if performed more than 48 h after admission. Hypothesis Some reasons for OTS delays are amenable to modification by measures aimed at decreasing the adverse impact of long wait times. Material and method We conducted a retrospective single-centre observational study. Of 18 495 who underwent surgery at the OTS centre of the Clermont-Ferrand university hospital in 2015–2019, 1946 had a post-admission wait time longer than 48 h. After exclusion of repeat surgical procedures and dressing changes, 1175 patients remained for the analysis. The records of each patient were reviewed to identify the reason for the surgical delay. Results A delay longer than 48 h was noted for 6.3% of OTS procedures. The most common reasons were limited resource availability (e.g., of operating theatres, nurses, or anaesthesia teams) (21.3%) and patient treatment by anticoagulants (20.9%). Conclusion Most delays were due to reasons independent from the patients operating-theatre logistics, delays in obtaining investigations) that could be targeted by those involved with operating-theatre management to diminish both surgical delays and hospital stay lengths. Level of evidence IV, retrospective observational cohort study.