Conservative management for the majority of patients with severe chest injuries has produced a reduction in mortality, complications, and hospital length of stay. More recently, operative stabilization of rib fractures has been used with the implication of improved outcome. We assessed the impact of operative rib fracture stabilization on outcome among trauma patients. A matched case-control study of patients undergoing operative rib fracture stabilization was performed. Thirty patients undergoing rib stabilization were matched with 30 controls. Length of intensive care unit (controls, 14.1 +/- 2.7 vs cases, 12.1 +/- 1.2, P = 0.51) and total hospital (controls, 21.1 +/- 3.9 vs cases, 18.8 +/- 1.8, P = 0.59) stay were similar for both groups. There was a trend toward fewer total ventilator days for operative patients (6.5 +/- 1.3 days vs 11.2 +/- 2.6 days, P = 0.12). Ventilator days for operative patients from the time of stabilization was 2.9 +/- 0.6 days compared with 9.4 +/- 2.7 days in controls (P = 0.02). Rib fracture fixation may reduce ventilator requirements in trauma patients with severe thoracic injuries. Long-term functional outcomes need to be assessed to ascertain the impact of this procedure.