Purpose <p>The study aim was to investigate the long-term outcomes after hardware removal (HR) in patients with blunt chest trauma. We hypothesized that HR might be beneficial in indicated patients to improve patient health.</p> Methods <p>We performed a retrospective single-center study between 2017 and 2023. Descriptive statistics were used for the analysis. One study-specific follow-up visit was conducted, 28 months (range 3–72) after HR. The study-specific health survey used, consisted of four functional dimensions (mobility, self-care, usual activities, mental health) and two symptom dimensions (thoracic pain, chest tightness) which were rated on a numerical scale and compared to the status before HR in four categories (much better to worse).</p> Results <p>Of the 28 patients, the average age was 59 years (range 29–83), 12 fractures (1–39) were fixed, and 4 implants (1–11) were used. The indications for HR were persistent thoracic pain (36%), discomfort (25%), chest tightness (21%), hardware dislocation (11%) and hardware infection (7%). HR was performed 18 months (5 days-104 months) after surgery for trauma. Patients with chest tightness and infection exhibited the greatest improvement in symptoms (75%), followed by those with hardware dislocation (61%). The improvement rate in the other 2 groups was 58%. All patients who experienced chest tightness, hardware dislocation and infection were completely satisfied and would undergo HR again.</p> Conclusion <p>HR is safe and feasible, resulting in significant symptom relief and improvement in health status in approximately two-thirds of patients. In indicated patients, HR might be performed earlier and more liberally if symptoms are disabling.</p> Clinical trial registration number <p>NCT06003595 registered on July 18, 2023.</p>