Objective The treatment of multiple rib fractures is worthy of consideration. A Meta-analysis on the surgical and conservative treatment of multiple rib fractures was carried out in this paper to explore the curative effect of these methods and provide some medical evidence. Methods Articles about randomized controlled trials (RCT) on the surgical and conservative treatment of multiple rib fractures were retrieved from the PubMed, Embase and Cochrane library databases, and were screened then to extract the data. The results were displayed by forest plots. Results This study included 5 articles and 337 cases which were divided into the surgical group (161 cases) and conservative group (176 cases). The Meta-analysis showed that differences between the two groups in respirator support time, intensive care unit (ICU) stay time, length of stay, and the incidence of pulmonary infection, chest wall deformity, chest tightness and breathlessness on exertion were statistically significant, and the differences between the two groups in the rate of tracheotomy and in-hospital mortality were not statistically significant. Conclusion The surgical treatment of multiple rib fractures can shorten the respirator support time, ICU stay time and length of stay, and reduce the incidence of pulmonary infection and chest disability, but this should be verified further by more randomized controlled trials. Key words: rib fractures; flail chest; surgical intervention; conservative treatment; Meta-analysis