OBJECTIVE: To report the outcomes of rib reconstruction after painful nonunion. DESIGN: Retrospective case series. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Between November 2007 and May 2013, 10 patients who presented with 16 rib nonunions and disabling pain were treated with reconstruction of their nonunited rib fractures. INTERVENTION: Rib nonunion reconstruction predominately with iliac crest bone graft and a tension band plate with a locked precontoured plating system for ribs. MAIN OUTCOME MEASUREMENTS: Demographic data, mechanism of injury, and number of rib nonunions were recorded. Operative procedure, length of follow-up, complications, Short Form Survey 36, and a patient questionnaire were also captured and documented. RESULTS: Eight of the 10 patients sustained their original fractures from a fall. Outcomes were available for the 10 patients at a mean follow-up of up of 18.6 months (range, 3-46 months). All 16 ribs went on to union with a mean time from reconstruction to union of 14.7 weeks (range, 12-24 weeks). At final follow-up, the mean mental and physical component Short Form Survey 36 scores were 54.4 and 43.5, respectively. Eight of the 10 patients were able to return to work and/or previous activities without limitations. Complications included 1 wound infection that resolved after irrigation and debridement with adjunctive antibiotics. One symptomatic implant was removed. CONCLUSIONS: Ten patients with 16 symptomatic rib nonunions were reconstructed using autologous bone graft and implant/mesh fixation manifesting in successful union with improved patient function and a low rate of complications.