Two hundred and seven patients with acute, unstable chest wall injuries were randomized to receive operative treatment (n=108) or non-operative treatment (n=99). The outcomes of interest included general health outcomes measured via the mental and physical component summaries (MCS; PCS) of the Short Form 36 (SF-36) questionnaire, assessed at 1 week, 2 weeks, 6 weeks, 3 months, 6 months, and 12 months follow-up. A multiple linear regression analysis was performed to determine if any baseline or injury factors were predictive of SF-36 scores at 1 year. Results revealed no significant differences between the operative and non-operative groups in both outcomes at all time-points. Results of the regression analysis demonstrated that patients who smoked (p=0.009), who sustained a hemothorax (p=0.04), and who spent longer in the ICU (p=0.002) had worse PCS scores at one year follow-up. Moreover, smoking was the only significant predictor of worse MCS scores at one year follow-up (p=0.0001).