Fig. 1

After the thoracoscopic examination and intervention, the fracture site of the targeted rib in the planned fixation was marked with a needle under thoracoscopic vision (a). The vertical limb of the mirror Judet incision was marked along the lateral border of the scapula to its lower tip, and then extended to the previously marked needle (arrowhead) to form a lazy L-shaped incision (b). The deep approach was taken through the interval between the infraspinatus and teres minor muscle to expose the fracture in the scapular neck or lateral border (c). Following the anatomical reduction and rigid fixation of the scapula (d), the approach continued down to the oblique limb of the mark for the planned rib fixation. Elevating the scapula is necessary if the targeted rib is higher than the seventh rib with the posterolateral fracture pattern (e). The deep approach for rib fracture is similar to the modified muscle-sparing posterolateral thoracotomy approach. Then, the targeted ribs were under direct vision, which facilitated surgical fixation (f). I, infraspinatus; D, deltoid; S, scapula