A total of 207 patients with a flail chest injury or severe chest wall deformity were randomized to receive surgical fixation (n=107) or the non-operative management (n=99). The outcomes of interest were the Short Form 36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, assessed at 1 week, 2 weeks, 6 weeks, 3 months, 6 months, and 12 months follow-up. The results demonstrated that both the PCS and MCS were not statistically significantly different (p=0.25; p=0.98, respectively) between the 2 treatment arms at any of the follow-up periods. Patients who smoked demonstrated worse SF-36 MCS and PCS scores at 1 year. Patients who spent longer in the intensive care unit (ICU) and patients who sustained a hemothorax reported worse SF-36 PCS scores.