Objective To investigate the value of CT scan and three-dimensional reconstruction in the evaluation of clinical treatment options and prognosis of femoral neck fractures. Methods The clinical data of 86 patients with femoral neck fractures who were admitted to the hospital from February 2015 to June 2016 were retrospectively analyzed. The patients were divided into the control group (undergoing X-ray examination before operation, n=35) and the observation group (undergoing CT scan and three-dimensional reconstruction scan before operation, n=51) according to the preoperative examination methods. With postoperative pathological results as the golden standard, the consistency of the two groups for diagnosis of the type of femoral neck fractures was evaluated. The performance of operation and prognosis were compared between the two groups. Results X-ray films diagnosed that types of femoral neck fractures in 4 patients were inconsistent with evaluation results, and the overall consistency was 88.57%. CT scan and threedimensional reconstruction examination diagnosed that the type of femoral neck fracture in 1 patient was inconsistent with evaluation results, and the overall consistency was 98.04 %. There were significant differences in ratios of closed internal fixation and artificial joint replacement between the two groups (P<0.05). The incidence rates of nonunion and femoral head necrosis in the observation group were significantly lower than those in the control group (P<0.05). Conclusion The clinical value of CT scan and three-dimensional reconstruction in the evaluation of clinical treatment options and prognosis of femoral neck fractures is significantly higher than that of X-ray plain film.