The strategy for treatment of flail chest remains controversial. Debate between MV and surgical fixation persisted for years. Methodology: Twenty patients were randomized into two groups, group I: was managed by MV. Group II was treated by surgical internal fixation. In group I, age ranged from 18-65 with mean 34.4 ± 13.38, while in group II age ranged from 21-69 with mean 44.2 ± 19.46. We used plates for fixation together with screws and stainless steel wires with which we observed more stability than the mere use of wires or absorbable sutures alone. Results: There was no statistical significant difference as regards the age, sex, associated injuries in both groups, the stability gained one month after the trauma, but there was significant difference regarding the mean duration of mechanical ventilation, ICU stay and incidence of chest infection in both groups. There was no statistical significant difference between both groups regarding hospital stay, morbidity and mortality although it is lower in the surgical group. Conclusion: Surgical fixation is a successful treatment modality in patients with traumatic flail chest as it avoids long term mechanical ventilation, resulting chest infection and allows early discharge from ICU with less mortality.