Purpose <p>Surgical stabilization of posterior rib fractures involving the costotransverse joint is debated, with most patients managed non-operatively. However, surgery may be indicated for respiratory failure due to altered mechanics or severe pain leading to functional limitations. Long-term outcomes related to quality of life and pulmonary function in these patients are underreported. This study aimed to describe our unique experience with the surgical stabilization of posterior rib fractures involving the costotransverse joint and to report the associated outpatient clinical outcomes.</p> Methods <p>An observational descriptive study was conducted at a tertiary care institution in Colombia during 2020–2024. Patients with posterior rib fractures involving the costotransverse joint who underwent surgery were included. Data collected included demographics, trauma severity, and complication rates. Primary outcomeswere mortality, postoperative complications, and implant failure.</p> Results <p>Eleven patients were included, with a median age of 42 years (interquartile range [IQR] 35–53). The median Injury Severity Score was 26 [IQR 21–35]. The median hospital length of stay was 13 days [IQR 10–17], Intensive care unit stay was 7 days [IQR 4–10], and invasive mechanical ventilation duration was 4 days [IQR 3–4]. One patient (9.1%) experienced a postoperative surgical site infection. Pulmonary function tests revealed a median forced vital capacity at 66% of the predicted value [IQR: 63–73%] and a median forced expiratory volume in the first second at 65% of the predicted value [IQR: 64–70%]. Quality of life assessments indicated acceptable outcomes, with a median score of 60 points [IQR 50–75].</p> Conclusion <p>Surgical stabilization of posterior rib fractures involving the costotransverse joint is feasible and yields favorable outcomes, overcoming many technical hurdles. Larger studies with standardized follow-up are needed to validate these findings and establish definitive management guidelines.</p>