Trauma patients with orthopedic injuries transferred to Harborview Medical Center (HMC) were compared with all trauma patients directly admitted to HMC and with a set of matched controls regarding Injury Severity Score (ISS) and age, if ≥50 years old. Groups were compared on ISS, Revised Trauma Score (RTS), ICU stay, length of stay (LOS), total charges, reimbursement, payors outcome. Comparison of all transferred patients and directly admitted patients showed significant differences in ISS, LOS, ICU stay total charges. Despite a higher ISS, transferred patients had no differences in RTS or survival outcome. Comparison of matched transferred patients and directly admitted patients on ISS and age if ≥50 years old showed a statistically significant increase in LOS, reimbursement charges. The survival rate of all transferred and directly admitted trauma patients was approximately 95% for both groups despite a slightly higher degree of injury in transferred patients. The reimbursement rate for both groups was low, 65% for transferred patients and 59% for directly admitted patients. The percentage of transfer patients on Medicaid was 34% and for direct admissions was 37% (p = 0.552). This is a large percentage of indigent care, since only 8.1% of Washington State residents are Medicaid dependent.