OBJECTIVES: Flail chest occurs in 6-15% of patients sustaining blunt chest wall trauma and can be life-threatening. It is typically managed through supportive therapies (e.g. ventilation, pain control) but an increasing body of evidence shows decreased patient mortality and morbidity with rib fixation surgery. The objective of our study was to evaluate the budget impact of changing the treatment for flail chest from supportive therapy to surgical management with contoured titanium plates in a Canadian hospital.  METHODS: A budget impact model was created using clinical and economic data obtained from peer-reviewed literature, the Ontario Case Costing Initiative and case costing data from a large Canadian hospital. A 2013 meta-analysis was used to provide efficacy data on the reduction of healthcare resources associated with surgical management. The outcomes are reflective of a hospital that treats 10 patients with flail chest per year. The model takes into consideration costs associated with surgery, length of stay and the common complications associated with flail chest. A multivariate sensitivity analysis utilizing a Monte Carlo simulation was conducted on economic and clinical parameters to ensure robustness. RESULTS: The model found that shifting the treatment of flail chest from supportive to surgical management decreased the number of ventilation days from 13.9 to 6.4 and the total hospital stay from 27.2 to 18.4 days. It also found a reduction in the incidence of complications such as tracheostomies from 78.94% to 18% and pneumonia from 89.47% to 62%. Accounting for the additional costs associated with fixation devices and surgical management, the model establishes that surgical rib fixation for flail chest has the potential to provide a Canadian hospital with an annual net cost savings of CAD$214,660. CONCLUSIONS: Shifting the treatment of flail chest from supportive to surgical management with contoured titanium plates is a cost-effective solution for Canadian hospitals.