Introduction and Aims: We studied the prevalence of smoking, the effect of hospital stay on motivation to quit and the exposure to smoking cessation advice in orthopaedic patients who required surgical intervention for acute extremity fractures. Design and Methods: This cross-sectional study involved a self-administered pen-and-paper survey assessing smoking status, interest and motivation to quit smoking, and current advice to quit among a consecutive cohort of patients aged 18-65 years old with acute extremity fractures. These patients were admitted to the John Hunter Hospital Level 1 trauma facility in New South Wales, Australia, for surgical intervention over a three month period. Results: A total of 183 patients (response rate 98%) completed the survey. Sixty-eight patients (37.2%) reported a current smoking habit. The prevalence of smoking was 42.2% among males and 25.5% among females. A total of 40% of smokers reported that they had not received advice to quit from medical staffduring hospital admission. Prior to admission, 12.1% of smokers were interested in smoking cessation; this percentage increased to 26.8% post-admission. Discussion and Conclusions: The prevalence of smoking among surgical patients with extremity fractures was found to be more than twice the prevalence of the population of New South Wales. Hospital admission had a positive impact on the patient's interest in smoking cessation. Our study suggests that the identification of orthopaedic patients who smoke is suboptimal, and the opportunity to encourage smoking cessation during hospital admission is currently being overlooked.