Objective To compare the efficacy between open reduction internal fixation and nonoperative treatment of multiple rib fractures.Methods Pubmed,Embase,Chinese National Knowledge Infrastructure database (CNKI),Chinese Biological Medical Literature database (CBM),Wanfang database and VIP database were searched for relevant studies comparing the effect of open reduction internal fixation and non-operative treatment of multiple rib fractures during 1990 and 2016.RevMan 5.3 software was used for the meta-analysis to compare differences of the two treatments concerning hospital stay,total ICU stay,duration of mechanical ventilation,proportion of pneumonia and atelectasis and pulmonary function.Results Eleven studies containing 799 patients met the inclusion criteria,including 431 patients in internal fixation group and 368 patients in non-operative group.Two groups had significant differences in hospital stay (95％ CI-11.00--3.34,P ＜-0.05),total ICU stay (95％ CI -4.48--1.29,P ＜ 0.05),duration of mechanical ventilation (95％ CI-7.52--1.54,P ＜ 0.05),proportion of pneumonia (95 ％ CI 0.19-0.42,P ＜ 0.05),proportion of atelectasis (95 ％ CI 0.24-0.57,P ＜ 0.05) and total lung capacity (95 ％ CI 1.57-1.97,P ＜ 0.05),forced vital capacity (FVC) (95 ％CI 0.98-1.27,P ＜ 0.05) and forced expiratory volume in one second (FEV1) (95％ CI 0.68-0.95,P ＜ 0.05).Conclusion Open reduction internal fixation of multiple rib fractures can significantly improve rehabilitation rate,reduce incidence of pulmonary complications dnring hospitalization,and facilitate recovery of lung function.