Introduction: Flail chest is a severe life threatening injury with mor- tality rates reaching up to 33%, traditionally treated with mechanical ventilation (“internal fixation”). Recently, some authors recommend a surgical approach for highly unstable flail chest. Several rib fixation techniques have been described although none are considered gold standard. Despite growing evidence of benefits for both the patient as well as the hospital, there is a general reluctance to perform rib fixation. In smaller hospitals such as the one referred to in this text, general sur- geons are called to manage these patients and as such, it is a prerequisite of their training to be aware of all available treatment options, including standard and novel surgical solutions for flail chest injury. Case description: The 3 cases involved polytrauma victims who have undergone emergency laparotomy because of abdominal injuries. Rib osteosyntheses were undertaken once the patients were haemodynami- cally stable. Perforated metal plates and screws were used in all cases. All patients were readily weaned off from ventilation with no post-surgical complications from the osteosynthesis and were subsequently discharged home well. All patients remain asymptomatic and no complications were registered during a 17 months (average) follow up. Conclusion: Surgical fixation of fractured ribs is a straightforward pro- cedure which promotes reestablishment of ventilatory dynamics. Despite several studies favouring the surgical approach to flail chest, many sur- geons are still reluctant to perform this procedure. The authors present a simple and reproducible technique, with good results.