Eighty-six patients with flail chest injuries were randomized to receive surgical stabilization (n=XX) or non-operative management (n=XX). The primary outcome of interest was pulmonary function, assessed by predicted FEV1 and FVC at 3 and 12 months post-injury. Secondary outcomes included changes in FEV1 and FVC over time. Overall, the results revealed no significant difference in pulmonary function between the two groups at either time point, though the surgical group demonstrated a greater improvement in predicted FEV1 from 3 to 12 months (5 vs. 1, p=0.026) and a trend toward improvement in FVC (7.3 vs. 3.7, p=0.07). These findings suggest that while surgery may offer some benefit in pulmonary function recovery over time, it does not lead to significantly better long-term pulmonary outcomes compared to non-operative management.