Introduction: Rib fractures lead to severe morbidity and mortality after trauma, and these risks increase exponentially in older patients and those patients with multiple fractures. There is ongoing debate about treatment with surgical rib fixation, particularly regarding indications for and timing of fixation. Most surgeons agree that there is a clear and important role for fixation for some patients. Minimally invasive techniques for rib fixation are gaining traction within the trauma community. Methods/Results: Our level 1 trauma center has recently performed a number of video assisted thoracoscopic surgical (VATS) internal rib reduction and fixation for complex rib fractures and flail chest. We present here a case of completely VATS surgical rib fixation of 4 total ribs with one flail segment on a 70 yo female after an assault. Our patient did very well and was discharged on post-operative day 4. Conclusion: We have seen that VATS internal rib fixation is a viable and exciting option for surgical fixation. Additional research is needed in order to delineate which specific patient populations will benefit, as well as to demonstrate cost effectiveness.