We report our experience with 12 patients whose chest wall injuries were treated with stable internal fixation by means of rib plates. Of all patients with chest wall injuries requiring inpatient treatment, only 5.19% were operated for this diagnosis; that is to say this operation is seldom indicated. In 5 patients stabilization was done "on the retreat" when thoracotomy had to be performed for intrathoracic injury anyway; in another 5 patients inadequate recovery from respiratory insufficiency following conservative treatment led to the operation, and in 2 patients extreme dislocation of chest wall fractures with restricted chest volume was the reason for surgical intervention. The mean age of these patients was 58 years, the mean PTS score 28.5 (ranging from 18 to 56), mean duration of postoperative mechanical ventilation 6 days (median 5 days), mean duration of stay in the intensive care unit 18 days, and duration of stay in hospital was 42 days, reflecting the severity of associated trauma. The stability achieved in the chest wall permitted sufficiently painfree spontaneous ventilation 1-5 days after the operation in 50% of patients. Two aged patients died of non-trauma-related myocardial infarction and myocardial insufficiency, respectively, while in hospital. Complications attributable to the specific surgical intervention were superficial infection of the incision (2 cases) and postoperative haemorrhage from an intercostal artery (1 case). No late complications related to the specific operative procedure occurred.(ABSTRACT TRUNCATED AT 250 WORDS)