46 patients presenting with traumatic flail chest injury were randomized to receive either operative treatment (rib fixation) or the standard nonoperative treatment to evaluate its effect on clinical and monetary outcomes. Results indicated that the operative group displayed reduced duration of intensive care unit (ICU) stay, reduced use of noninvasive ventilation and reduced incidence of tracheostomy compared to the nonoperative group. At the 3- and 6-month follow-ups, there were no differences between groups in spirometry results and Short-Form 36 questionnaire results, respectively. Results also demonstrated that operative treatment was more cost-effective than non-operative treatment.