11 studies involving 753 patients were included in this meta-analysis to compare the results of surgical fixation versus nonoperative management for flail chest injuries. Results indicated that surgical fixation led to greater clinical care benefits; this treatment led to substantial decreases in ventilator days and reduced the odds of developing pneumonia when compared to nonoperative treatment. However, the reader should be apprehensive when drawing conclusions from this meta-analysis as it was based primarily on small retrospective studies, only including two randomized trials.