Objective: Blunt thoracic traumas are often complicated with rib fractures. The decision-making process of the treatment approaches not clear for clinicians. So, we aim to investigate the effect of surgical intervention on pain management of patients as treatment indication. Methods: Cases with 3 or more rib fractures were evaluated in our study. Between 2014-2018, 367 patients with multiple rib fractures were admitted to our hospital. Of the 367 patients, 238 were included in this study. Among them 84 cases with multiple rib fractures that underwent surgery within fist 36 hours, 27 cases were operated after the 7th day 127 patients were managed conservatively. The results of hospitalization time, pneumonia, rates, thoracic deformity rates on 6.month thorax computerized tomography, intercostal blockage requirement, postoperative 6.month quality of life questionnaire for pain and clinical outputs were retrospectively analyzed. Results: The average hospitalization was found that it was significantly different in favor of the surgical group (z = 6.674; p
 Özkan S, Tetik GB, Tahtacı R, et al. Retrospective Analysis of 513 Cases Diagnosed with Rib Fracture Secondary to Blunt Thorax Trauma. J Clin Anal Med 2017;8(3):181-4.
 Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization?: a prospective randomized study of management of severe flail chest patients. J Trauma 2002;52:727-32.
 Soderlund T, Ikonen A, Pyhalto T, et al. Factors associated with in-hospital outcomes in 594 consecutive patients suffering from severe blunt chest trauma. Scand J Surg 2015;104:115–20.
 Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surgery & Acute Care Open 2017;2:1–7.
 Pape HC, Remmers D, Rice J, et al. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma 2000;49:496–504.
 Todd SR, McNally MM, Holcomb JB, et al. A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients. Am J Surg 2006;192:806-11.
 Elie G, Pierre EF, Nicola S, et al. Does surgical stabilization improve outcomes in patients with isolated multiple distracted and painful non-flail rib fractures? Interactive CardioVascular and Thoracic Surgery 2012;14 :312–315.
 Jaap S, J. C. Goslings, T. Schepers. Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review. Eur J Trauma Emerg Surg 2017;43:163–68.
 Martin TJ, Eltorai AS, Dunn R, et al. Clinical management of rib fractures and methods for prevention of pulmonary complications: A review. Injury 2019 ;50(6):1159-65.
 Eun Gu Hwang, Yunjung Lee. Effectiveness of intercostal nerve block for management of pain in rib fracture patients. J Exerc Rehabil 2014; 10(4): 241–44.
 Khosa AH, Durrani HD, Wajid W et al. Choice of Analgesia in Patients with Critical Skeletal Trauma. Cureus 2019 ;11(5): e4694.
 Kerr VMA, Arthur M, Mullins RJ, et al. Rib fracture pain and disability: Can we do better? J Trauma 2003;54(6):1058-63.
 Richardson JD, Miller FB, Carrillo EH, et al. Complex thoracic injuries. Surg Clin North Am 1996;76(4):725-48.
 Mayberry JC, Kroeker AD, Ham LB, et al. Long-term morbidity, pain, and disability after repair of severe chest wall injuries. Am Surg 2009;75(5):389-94.
 Ahmed Z, Mohyuddin Z. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg 1995;110(6):1676-80.
 [Nirula R, Diaz JJ, Trunkey DD, et al. Rib fracture repair: indications, technical issues, and future directions World J Surg. 2009 ;33(1):14-22.
 Ciraulo DL, Elliott D, Mitchell KA, et al. Flail chest as a marker for significant injuries. J Am Coll Surg 1994;178(5):466-70.
 Lee RB, Bass SM, Morris JA, et al. Three or more rib fractures as an indicator for transfer to a Level I trauma center: a population-based study. J Trauma 1990;30(6):689-94.
 Girsowicz E, Falcoz PE, Santelmo N, et al. Does surgical stabilization improve outcomes in patients with isolated multiple distracted and painful non-flail rib fractures? Interact Cardiovasc Thorac Surg 2012;14:312–5.
 Granetzny A, AbdEl-Aal M, Emam E, et al. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardio Vasc Thorac Surg 2005;4(6):583-7.
 Unsworth A, Curtis K, Asha SE. Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery. Scand J Trauma Resusc Emerg Med 2015;23:17.
 Slobogean GP, MacPherson CA, Sun T, et al. Surgical fixation vs non-operative management of flail chest: a meta-analysis. J Am Coll Surg 2013;216:302–11.e1.
 Rauchwerger JJ, Candido KD, Deer TR, et al. Thoracic epidural steroid injection for rib fracture pain. Pain Practice 2013;13:416–21.
 Baker EJ, Lee GA. A Retrospective Observational Study Examining the Effect of Thoracic Epidural and Patient Controlled Analgesia on Short-term Outcomes in Blunt Thoracic Trauma Injuries. Medicine (Baltimore) 2016 ;95(2):e2374.
 Beks RB, Peek J, de Jong MB, et al. Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis. Eur J Trauma Emerg Surg.2019 ;45(4):631-44.
 Liang YS, Yu KC, Wong CS, et al. Does Surgery Reduce the Risk of Complications Among Patients with Multiple Rib Fractures? A Meta-analysis. Clin Orthop Relat Res 2019 ;477(1):193-205.
 Cheema FA, Chao E, Buchsbaum J, et al. State of Rib Fracture Care: A NTDB Re-view of Analgesic Management and Surgical Stabilization. Am Surg 2019 ;85(5):474-78.
 Marasco SF, Martin K, Niggemeyer L, et al. Impact of rib fixation on quality of life after major trauma with multiple rib fractures. Injury 2019 ;50(1):119-24.