Objective To study the application value of multi-slice spiral CT (MSCT) in femoral neck fracture surgery. Methods One hundred patients with femoral neck fractures treated in our hospital between January 2013 and May 2015 were selected as study subjects and were examined by X-ray and MSCT. With surgical results as the golden standard, the coincidence rates were compared between X-ray and MSCT three-dimensional reconstruction technique in the diagnosis of femoral neck fracture anatomic type and Garden type. After 2 years of follow-up, the incidence rates of fracture nonunion and femoral head necrosis were statistically analyzed. Results With surgical anatomic type and Garden type as criteria, the coincidence rates of MSCT three-dimensional reconstruction technique in the diagnosis of anatomic type and Garden type (98.00% and 100.00%) were significantly higher than those of X-ray films (86.00% and 82.00%) (P<0.05). In 2 years after surgery, there were 1 case died and 2 cases lost to followup, and the incidence rates of femoral head necrosis and nonunion were 8.25% and 3.09% respectively. Conclusion Compared with X-ray plain film, MSCT three-dimensional reconstruction technique has obvious advantages in the diagnosis of femoral neck fractureanatomic type and Garden type, which can guide surgical treatment, reduce postoperative femoral head necrosis, nonunion and other complications.