Objective To investigate the preoperative evaluation and clinical application value of multi-slice spiral CT plain scan and three-dimensional reconstruction for radial fractures. Methods Retrospective analysis was performed on the case data of 76 patients with radial fractures treated in our hospital from August 2016 to June 2018. The diagnostic coincidence rate of different examination methods for radial fractures was analyzed, and the imaging characteristics of radial fractures were summarized. Results MSCT and 3d reconstruction examination revealed significantly more radial distal fracture masses than X-ray, sagittal fracture displacement distance and coronal area of wrist surface collapse were also significantly greater than X-ray, and the diagnostic coincidence rate of radial fracture classification was significantly higher (97.37%) than X-ray examination (65.79%) (P<00.05). CT plain scan can show compression collapse in the articular surface of fracture, discontinuous bone cortex and free bone shadow can be seen in the sagittal plane, 3d reconstruction examination can show involvement of the distal articular surface and free bone shadow can be seen in the sagittal plane. Angular deformity occurred at the broken end of the fracture, and the gap of the wrist joint was narrowed. All patients were treated with open reduction and internal fixation according to the images. Postoperative X-ray examination showed that the alignment of the broken end was good. Conclusion MSCT and 3d reconstruction have higher diagnostic coincidence rate for radial fracture, and relevant surgical plans can be made according to clinical image data, which is more favorable for patients' recovery.