Introduction From the beginning of the twentieth century till the current time, an overview is presented of the surgical treatment for rib fractures and flail chest. Methods Many techniques have been used to stabilize the thorax wall. There has been no follow-up for the most described techniques and the evidence provided is at its best at L3-4. This, together with the noninvasiveness of mechanical ventilation, has made the latter the golden standard. Conclusion However, the recent introduction of better and fully dedicated materials provides the possibility of exploring the surgical treatment of chest injuries. The authors make a case for operative treatment of rib fractures and flail chest.