Background: The operation theatre complex is an important pillar of any hospital and its optimum and efficient functioning reflects on the overall functioning of any busy hospital. There is no study done till date on the operation theatre utilization (OTU) in Oman and its cost effectiveness. This audit is carried out on the utilization of orthopedic trauma theatre, which can be used as reference for other specialty operation theatres and overall theatre efficiency in our hospital. Methods: Prospective audit was carried out over period of 1-year in Department of Orthopedics, Nizwa Hospital and data collected from our hospital were analyzed. All the components of the operation theatre were taken into account to arrive at theatre utilization, end utilization (EU), and operating timing. Results: Totally, 853 cases were electively operated upon during from 1st January 2011 to 31st December 2011 in orthopedic operation theatre, which was run for 261 days electively during that period. 74% cases started later than scheduled time with average of 22.8 min late start time. The total operating time was 81% of the total allocated theatre time with a mean of 05:15 h. The total surgical and anesthesia time (63%) and (15%), respectively. Changeover time was 70.39 h (4%) with average of 22.6 min and no useful activity amounted to total of 310.32 h (18%)based on above calculations it amounted to EU of 94% and OTU of 81.8%, respectively. 4.2% cases were cancelled for various reasons. Conclusion: The various reasons for underutilization of the orthopedic operation theatre are due to delay in starting list, increase changeover time, anesthetic, surgeon, and administrative factors. The corrective measures which can be applied to improve this have been discussed.