Objective To analyze the application value of multi-slice spiral CT and threedimensional (3D) reconstruction in the diagnosis and typing of tibial plateau fractures. Methods 71 patients with tibial plateau fractures confirmed by operation in our hospital between May 2012 and June 2015 were enrolled in the study. All patients were taken DR (digital radiography) plain film of the adem position of knee joint. Besides, they had undergone multi-slice spiral CT examination and compared with the operation results. The value of different imaging methods in the diagnosis and typing of tibial plateau fractures was compared. Results The accuracy rates of CT in typing of type I, type II, type IV and type V tibial plateau fractures were slightly higher than those of DR but the differences was not significant (P>0.05). The overall accuracy rate of CT typing (94.4%) was higher than that of DR (77.5%) (P<0.05). The detection rate of CT for fractures (95.8%) was higher than that of DR (85.9%) (P<0.05). The detection rate of DR for intercondylar eminence fractures (70.4%) was lower than that of CT (96.3%) (P<0.05). The detection of DR for fibular fractures (65.0%) was also lower than that of CT (95.0%) (P<0.05). Conclusion To apply multislice spiral CT combined with 3D reconstruction technique in the diagnosis of tibial plateau fractures, the detection rate of fractures is high and coincidence rate of typing is also high. The sensitivities in diagnosis of complicated fibular fractures and intercondylar eminence fracture are good.