Purpose <p>This study evaluated the efficacy of computed tomography (CT)-based three-dimensional (3D) stereotactic localization for surgical stabilization of rib fractures (SSRF).</p> Methods <p>A retrospective analysis of 54 patients undergoing rib fracture fixation was performed: 33 in the 3D stereotactic localization group and 21 in the conventional intraoperative localization group. Number of fracture sites fixed, number of surgical incisions, use of thoracoscopy, localization accuracy, preoperative Visual Analogue Scale (VAS) score, VAS score on the third postoperative day, delta of VAS scores, surgical field exposure time, intraoperative blood loss, average incision length per plate, drainage volume on the first postoperative day, postoperative hospital stay, and incidence of complications were compared.</p> Results <p>No statistically significant differences were observed between the two groups in the number of fixed fractures, surgical incisions, VAS scores (preoperative, postoperative, and delta of VAS scores) or incidence of complications. The 3D group exhibited significantly higher localization accuracy (94.21% vs. 75%) and superior perioperative outcomes including shorter exposure time, less blood loss, smaller incision, reduced drainage, and shorter hospital stay.</p> Conclusion <p>The CT-based 3D stereotactic localization method is an effective and valuable technique for SSRF, improving localization accuracy and superior perioperative outcomes.</p>