Objective: This paper is aimed at investigating the efficacy of combining internal fixation using prefabricated rib-locking titanium plate with ultrasound-guided thoracic paravertebral nerve blockade in treating multiple rib fractures among the elderly., Methods: Retrospective analysis of 221 elderly patients with multiple rib fractures treated from February 2016 to November 2020. According to whether surgery was performed, they were divided into the plate-blockage combination group (surgical group, 102 cases) and conservative treatment group (non-surgical group, 119 cases). The surgical group consisted of 58 males and 44 females aged from 60 to 85 years old, with an average of (67.2±3.6 ) years old, who suffered from 3 to 12 rib fractures with an average of (5.3±2.1) fractures. The non-surgical group consisted of 66 males and 53 females aged from 60 to 84 years old with an average of (66.8±3.2) years old, who suffered from 2 to 11 rib fractures with an average of(6.1±2.3) fractures. The clinical data, efficacies observed, and complications associated with both groups were compared and analyzed., Results: There was no significant difference in preoperative clinical data between two groups ( P >0.05), and all patients were discharged smoothly. Pulmonary infection ( P =0.028), atelectasis ( P =0.032), respiratory failure ( P =0.026), time to get out of bed ( P =0.040), time to fracture healing ( P =0.035), length of hospital stay in the operation group ( P =0.043), visual analogue scale (VAS) at 3 days ( P =0.028), 5 days( P =0.032), and 7 days( P =0.019), maximal voluntary ventilation (MVV) at 3 months after surgery ( P =0.042), forced expiratory volume in one second (FEV1)( P =0.035), and maximal voluntary ventilation at 6 months, the maximal voluntary ventilation(MVV)( P =0.021) and forced FEV1( P =0.026) were all significantly better than those in non-surgical treatment group., Conclusion: For elderly patients with severe multiple rib fractures, the proposed plate-blockade combination can timely and effectively relieve pain, restore thoracic stability, shorten hospital stay, and reduce the incidence of complications such as pulmonary infections and acute respiratory distress syndrome(ARDS) compared with non-surgical treatments. Prefabricated rib-locking titanium plates have proved to demonstrate high clinical efficacy in treating multiple rib fractures among the elderly.