Chest wall trauma and rib fractures are significant sources of morbidity and mortality in countries in which motor vehicle accidents are prevalent. Physicians who care for injured patients should realize that patients with thoracic trauma are at significant risk for mortality, deterioration, and associated injuries. Care must be taken to avoid underestimation of the effect of the injury on subsequent respiratory mechanics. Armed with an understanding of chest injury epidemiology, biomechanics, and pain control, physicians can better serve these high-risk patients.