Nine randomized controlled trials including 862 patients with traumatic multiple rib fractures were included in this systematic review and meta-analysis comparing operative management to nonoperative management. Pooled outcomes of interest included all-cause mortality, incidence of pneumonia, duration of mechanical ventilation, ICU length of stay, and hospital length of stay. The results demonstrated that operative management significantly reduced the duration of mechanical ventilation and the incidence of pneumonia, but did not significantly impact all-cause mortality. The findings suggest that while operative management may improve some clinical outcomes, further research is needed to establish its effect on mortality due to the low certainty of evidence and insufficient sample size.