If a person has more than one fractured rib, severe damage, or flail chest, they may need surgery. During the operation, a surgeon will use plates and screws to fasten the broken ribs together.

Focal retractions suggests bronchial obstruction, flail chest, or constrictive pericarditis (Broadbent's sign) if over the heart. With flail chest, the ribs themselves show paradoxic movement.