Background and Aim: Rib fractures are common injuries resulting from traumatic events, often leading to significant complications. First rib fractures, though rare, are associated with critical structures and severe outcomes. This study aims to explore the mechanisms, complications, and management strategies of rib fractures, with a particular focus on first rib fractures and their sequelae. Material and Methods: A prospective randomized trial was conducted on 380 patients, analyzing the mechanism of injury, treatment options, complications, and patient outcomes. Results: Road traffic accidents were the leading cause of rib fractures. Conservative treatment was most commonly used, although some patients required intercostal drainage or thoracotomy. The majority of patients were discharged with minimal complications. Conclusion: Rib fractures, especially first rib fractures, require a comprehensive management approach, with early diagnosis and timely intervention to prevent severe complications.