Fig 1. Illustrative case of a patient who underwent surgical stabilization of rib fractures.

(A) Video-assisted thoracoscopic surgery (VATS) was utilized to clear the pleural space prior to open reduction internal fixation (ORIF) for rib fractures. The fractured fragment had penetrated through the parietal pleura causing hemothorax. (B) Lung laceration with air leakage was noted and repaired with a linear cutter stapler. (C) The patient underwent combined VATS and ORIF with locking plates through a muscle-sparing approach without thoracotomy. (D) The intercostal and chest-wall muscles were well-preserved after ORIF through this approach.