The question that many patients struggle with after a rib fracture is: Should I have surgery or not? Is it better to operate or is it better to treat conservatively? Here I will briefly explain the specific cases in which your doctor may recommend you to open surgery. The most obvious symptom after a rib fracture is pain, which is more pronounced when changing position (lying down or sitting up), coughing, deep whistling, etc. It can be said to be “whistling pain”. This is because the fracture is misaligned and pulls on the intercostal nerve, causing pain. Patients are often afraid to get up and cough up sputum for fear of pain, resulting in sputum not being easily coughed up and further complications such as pneumonia, atelectasis, and bed sores. Although surgery does not provide immediate pain relief, it can shorten the time spent in bed, reduce the pain level and promote rapid recovery. 2, the whistling function is affected After the fracture, the broken end of the fracture, the intercostal vessels rupture and bleed, and the broken end punctures the pleura, lung and diaphragm can cause blood accumulation in the chest cavity and pneumothorax, resulting in pressure on normal lung tissue. In case of severe rib fractures with multiple segments, the ribs cannot support the normal shape of the thorax and the chest wall is softened, which may lead to continuous shackle chest, paradoxical whistling, and mediastinal oscillation, resulting in restricted ventilation and air exchange functions. In addition, severe fractures are often accompanied by pulmonary contusions, which together aggravate whistling and circulatory dysfunction, resulting in whistling failure, and patients often require whistler-assisted ventilation. In such patients, surgery can provide ideal internal fixation of the chest wall, effectively control paradoxical whistling, ensure adequate ventilation, and improve the patient’s hypoxemia and whistling distress. 3, fracture misalignment is obvious Some traumatic injuries lead to rib fracture misalignment is very obvious, even if the complications such as bleeding and pain are cured by conservative treatment, but the discontinuous ribs can cause thoracic deformity and softening, affecting the whistling function and losing the role of protecting the organs in the chest cavity. In some cases, the ribs of the chest wall may even “move around” during activities, making it impossible to perform heavy work and seriously affecting the quality of life. The surgery can achieve the effect of fracture anatomical repositioning through rib splints, restore the normal shape of the thorax, and ensure the quality of life after healing. 4.Injury to important organs External impact causing rib fracture and poking to the inside can lead to different injuries depending on the location: trauma to the left upper abdomen may lead to spleen rupture and bleeding, trauma to the right upper abdomen may lead to liver rupture and bleeding, trauma to the chest and back may lead to lung rupture leading to bleeding and pneumothorax, and trauma to the upper abdomen may also cause rupture of the diaphragm, forming a thoracoabdominal penetrating injury. In the event of these comorbidities of visceral injury, surgery is generally recommended to stop the bleeding and fix the ribs to avoid re-injury of the severed ends to the internal organs, thus saving lives. Of course, the actual clinical situation is very variable, and the specific feasibility of surgery needs to be evaluated by the attending thoracic surgeon, so the above experience is only for your reference, and we hope it will help you.