INTRODUCTION: The vast majority of rib fractures are successfully treated nonoperatively, but certain patients develop symptomatic nonunion. Common complaints include pain with coughing, tenderness to palpation, and a sensation of clicking or jabbing with deep respiration. There is a paucity of literature on reconstruction of rib nonunions. The purpose of our study is to detail the surgical and functional outcome after rib nonunion reconstruction. METHODS: Between November 2007 and July 2012, 7 patients who presented with 12 rib nonunions and disabling pain were treated by a single surgeon with reconstruction. Definition of a rib nonunion included clinical symptoms and a persistent fracture line on CT at least eight months after the original injury. Radiographs were assessed for fracture healing and clinical visits were reviewed for patient complaints and/or complications. Short Form 36 (SF36v2) and an author- derived patient questionnaire were mailed to the patients for assessment of their recovery. RESULTS: Preoperatively, 6/7 patients were limited or could not work due to nonunion-related symptoms. Four of the 6 patients complained of a painful clicking, 5/7 complained of pain with respiration, and all 7 patients reported pain that woke them at night. The average length from injury to surgical rib reconstruction was 22 months (range, 9-51). At a mean follow-up of up to 19 months (range, 6-46), all 12 ribs went on to union with a mean time from reconstruction to union of 16 weeks (range, 12-24). At final follow-up, the mean SF-36 scores were similar to those of a normal population for the patients with greater than one year of follow-up (n=5). Four of the five patients with greater than 12 months follow-up were able to return to work and/or previous activities without limitations. Complications included one wound infection that resolved after irrigation and debridement and antibiotics. One implant was removed for symptoms. CONCLUSION: Successful treatment of symptomatic rib nonunion is possible with good functional outcomes and a low complication rate.