Objective <p>To investigate the clinical efficacy of total thoracoscopic memory alloy embracing fixator(MAEF) internal fixation surgery for multiple rib fractures.</p> Methods <p>A retrospective analysis was conducted on the clinical data of 83 patients with multiple rib fractures who underwent surgical treatment in our department from September 2020 to February 2025. The patients were divided into an observation group (total thoracoscopic group, <i>n</i> = 40) and a control group (traditional incision group, <i>n</i> = 43) according to the surgical method. The clinical data of the two groups were compared.</p> Results <p>The operative time in the observation group was longer. However, after stratification according to the learning curve, it was found that the operative time in the observation group showed no significant difference compared with the control group after the surgical technique became proficient (<i>P</i> &gt; 0.05). The pain index and partial pressure of oxygen one day before surgery, intraoperative blood loss, postoperative pleural drainage volume, and fracture healing status in the observation group showed no significant differences compared with the control group (<i>P</i> &gt; 0.05). Pain scores and oxygen partial pressures on postoperative days 3 and 5 were significantly better in the observation group than in the control group(<i>P</i> &lt; 0.05). The postoperative hospital stay duration was significantly shorter in the observation group than in the control group (<i>P</i> &lt; 0.05).</p> Conclusion <p>The total thoracoscopic MAEF internal fixation surgery for multiple rib fractures is easy to learn, causes minimal trauma, and allows for a rapid postoperative recovery. The fracture healing achieved is comparable to that of open thoracotomy surgery.</p>