Rib fractures are frequent in trauma patients, being most of them managed on a non-surgical way. However, in selected cases, it is advocated. Chest wall stabilization (CWS) only recently has been best characterized. Available data shows plenty of benefits related to CWS versus non-surgical treatment in selected cases. Even though, it is only performed in a small number of patients according to some national databases. There are lots of topics to define concerning CWS such as the subgroups that benefit most, the time of surgery, which ribs should be stabilized and which incision should be performed. Most of these subjects need to be tailored for each patient. So far, no guidelines for CWS are available, although some algorithms have been proposed based on a combination of clinical experience and risk factors. In high-volume trauma centers it has become a common procedure. The complexity of some cases demands a careful evaluation, especially in the context of multiple injuries, and it should be taken into account in the decision.