Purpose: Traumatic diaphragmatic injuries (TDI) are rare but potentially life-threatening, typically resulting from high-energy blunt or penetrating trauma. In Aotearoa New Zealand, patients in the Southern region often present to rural hospitals such as Southland Hospital. Although these centres have general surgical capacity, some cases require transfer to tertiary centres for subspecialist input. However, there is limited local data describing real-world patterns of transfer, operative management, and outcomes in a rural–tertiary trauma network. Methodology: We conducted a retrospective observational study of patients admitted with radiologically or intraoperatively confirmed TDI across the Southern DHB region from May 2015 to May 2025. At the time of analysis, data collection was complete to November 2023. Patient data were extracted from electronic medical records, including operative notes, radiology, discharge summaries. Descriptive analysis was performed. Results: Ten patients were identified (9 male; median age 50 years). The majority sustained blunt trauma (n=7). Six patients (60%) were transferred to tertiary centres, while four (40%) were managed locally at Southland Hospital. Nine patients (90%) underwent operative repair—seven via laparotomy and two via laparoscopy. Only one patient received laparotomy prior to transfer. One patient (10%) was managed non-operatively following multidisciplinary discussion. The median length of hospital stay was 13.5 days (range 5–66). Complications included ARDS and hospital-acquired pneumonia. One patient died post-operatively from trauma severity. Conclusion: This is the first regional audit of TDI management in Southern New Zealand. Most patients required transfer, but several were managed surgically at the regional centre. These findings support early recognition, coordinated escalation, and shared trauma pathways. Further data collection may inform clearer triage criteria and regional surgical planning.