Mutual burdening in polytrauma considerably makes the diagnostic and therapeutic process difficult, delays the specialized care, e.g. for the concurrence of craniocerebral and thoracic trauma or that of skeletal injury and chest trauma, and imposes stringent requirements on the choice of diagnostic and therapeutic measures. Objective. To enhance the efficiency of combination treatment using minimally invasive techniques in patients with severe concomitant polytrauma and dominant chest injury (SCCI). Subjects and methods. The results of treatment were analyzed in 263 patients with SCCI. A study group of patients (n=109 (41.5%)) underwent modern minimally invasive interventions (local differentiated fibrinolytic therapy, valvular bronchial blocking, videothoracoscopy, and angle stable plate osteosynthesis for rib fractures). A comparison group of patients (n=154 (58.5%)) received traditional treatment (blind pleural drainage, thoracotomy, etc.). Results. A diagnostic and treatment algorithm was elaborated to manage patients with SCCI. The authors formulated indications for emergency thoracotomy, emergency and urgent videothoracoscopy, local fibrinolytic therapy for clotted hemothorax and posttraumatic pleural empyema, valvular bronchial blocking for tense or long-term unstretched pneumothorax, as well as indications for angle stable plate osteosynthesis for fragmentary rib fractures. Conclusion. The developed minimally invasive treatments could decline the number of thoracotomies and large-scale open surgery by 3.3 times, which also substantially reduced the number of patients operated on. The authors could also increase the number of patients discharged with recovery.