The goal of this observational study is to compare two localization methods used before surgical stabilization of rib fractures (SSRF): mixed reality (MR) and ultrasound-guided.

Main Research Question Before SSRF, does MR help surgeons mark rib fracture locations more accurately (in centimeters) and faster than ultrasound-guided?

Participants After the study ends, all participants will keep follow-up at the thoracic surgery clinic. The team will record wound healing and pain scores for use in the observational study.

Inclusion Criteria:

1. Ages 18 to 80 years
2. Computed tomography (CT) demonstrates ≥3 rib fractures, and the patient meets indications for surgical stabilization of rib fractures (SSRF).
3. Able to understand the study and provide written informed consent.

Exclusion Criteria:

1. Uncorrected coagulopathy.
2. Known osteoporosis or pathologic fractures.
3. Respiratory failure or hemodynamic instability requiring emergent surgery.
4. Declines to participate or withdraws consent.

Hospitalized adults 18-80 years with CT-confirmed ≥3 rib fractures who meet indications for surgical stabilization of rib fractures (SSRF) at participating thoracic surgery services. Participants are managed under routine care and, as part of preoperative planning, receive both mixed reality (MR) and ultrasound surface marking to enable within-subject accuracy comparisons. Enrollment is prospective (non-probability sampling). Key exclusions include uncorrected coagulopathy, known osteoporosis or pathologic fractures, and respiratory failure or hemodynamic instability requiring emergent surgery.