Rural and remote communities face significant challenges accessing orthopaedic care despite comparable presentation rates to metropolitan hospitals. Motor vehicle accidents, agricultural and mine-related injuries, and assaults create substantial demand. However, the lack of on-site specialists leads to delayed diagnoses, prolonged treatment wait times, and preventable complications. Mount Isa Hospital (MIH), the primary referral centre for the North-West Hospital and Health Service in far North Queensland, lacks on-site orthopaedic services. With the nearest orthopaedic care 900 km away at Townsville University Hospital, over 40% of MIH’s surgical transfers involve orthopaedic cases, such as fractures and infections, requiring emergency referrals. Dedicated orthopaedic surgical practices in remote areas do not currently exist, and the rapid“fly-in, fly-out” model does not adequately fulfil healthcare needs. Establishing local orthopaedic services would improve outcomes, reduce delays, and lower transfer-related costs. Rural orthopaedic surgeons must possess broad trauma, fracture care, and musculoskeletal rehabilitation skills. Rural rotations in orthopaedic training can prepare trainees for these challenges and support community needs. Telehealth Fracture Clinic has successfully facilitated patient assessment, follow-up, and continuity of care at MIH for 17 years through collaboration with Princess Alexandra Hospital in Brisbane, demonstrating its potential to manage non-operative cases and ensure equitable access for rural and remote communities. Empowering on-site orthopaedic practitioners to serve these regions, as well as through training and telehealth expansion, will ensure high-quality, accessible care for all.