BACKGROUND: Costal cartilage injuries are unappreciated, and there is a paucity of reports on fixation methods. This study aims to evaluate the safety of titanium plate internal fixation for costal cartilage injuries. METHODS: A retrospective analysis was conducted on 30 patients with costal cartilage injuries who underwent titanium plate internal fixation between April 2016 and November 2022 at our hospital. The internal fixation devices consisted of titanium plates and locking screws, securing 60 costal cartilage injury sites. Injuries were classified based on the fixation location: costal cartilage-costal cartilage (22 sites), bone (sternum, rib)- costal cartilage (24 sites), and bone (sternum)- costal cartilage-bone (rib) (14 sites). Follow-ups at 1, 3, 6, and 12 months postoperatively included CT assessments to evaluate injury healing and the presence of displacement or screw loosening. RESULTS: The average lengths of the titanium plates used for the three different fixation positions were 6, 7, and 10 holes, respectively, with at least two locking screws securing each end. The maximum follow-up period was 90 months, with 6 cases lost to follow-up (3 at 1 month postoperatively, affecting 4 fixation sites, and 3 at 3 months postoperatively, affecting 6 fixation sites). Excluding these cases, all fixed costal cartilage injuries healed without nonunion or displacement, with two instances of screw loosening observed at 1 month postoperatively. CONCLUSION: Titanium plate fixation with locking screws is a safe and effective method for treating costal cartilage injuries, with all patients showing good injury healing.