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Relevance. Rib pseudoarthrosis is a rare outcome of rib fractures, characterized by the absence of bony union and the formation of a pathological fibrous–osseous connection with mobility at the defect site. In some cases, herniation of lung tissue may occur. Although this complication is uncommon and reported only in isolated case reports and small series, it can result in significant pain, respiratory impairment, and ischemic changes in the pulmonary parenchyma. Determining the optimal management strategy for patients with this pathology remains a relevant and clinically significant issue in modern thoracic surgery. Materials and methods. We present a clinical case of a 50-year-old patient hospitalized in a thoracic surgery center six months after an occupational injury, with rib pseudoarthrosis complicated by a lung hernia. On admission, the patient complained of persistent dull pain in the left chest and a palpable protrusion at the site of the pseudoarthrosis. For further diagnostic clarification, computed tomography with 3D reconstruction was performed. Video-assisted thoracoscopy was carried out to repair the lung hernia, combined with sequential stable fixation of the rib pseudoarthrosis. The operative time was 105 minutes, and blood loss was 50 mL. Preoperative imaging findings, the surgical procedure, and the postoperative outcomes are presented. At three months postoperatively, the patient reported no complaints; follow-up CT confirmed consolidation of the rib fractures and the absence of intrapleural complications. The total sick leave after surgery was 90 days, and the patient returned to his occupation as a truck driver. Conclusions. This case report demonstrates the effectiveness of a surgical approach combining stable fixation of rib nonunion with simultaneous repair of an intercostal lung hernia. The observed outcomes support the appropriateness of surgical management for symptomatic rib pseudoarthrosis, particularly in cases complicated by lung herniation. This approach ensures reliable stabilization of the thoracic cage, alleviates pain, and reduces the risk of recurrent complications.