Objective To explore the effects of spiral CT reconstruction in the diagnosis and treatment of ankle fracture. Methods The clinical data of 88 patients with ankle fractures were retrospectively analyzed. All patients were given spiral CT reconstruction scan before and after operation, and axial images and 3d reconstruction images were obtained, and they were classified according to Lauge-Hansen ankle fracture classification criteria, and surgical findings were as "gold standard". The accuracy of two images in differential diagnosis of ankle fracture classification was compared before operation, and the surgical reduction and internal fixation quality evaluation of two images after operation were analyzed. Results The diagnostic accuracy of ankle fracture classification by spiral CT 3d reconstruction images was significantly higher than that by axis images [97.73% (86/88) vs 88.64% (78/88)] (P<0.05). The cases of non-anatomical reduction and unsatisfactory placement in ankle fracture reduction and internal fixation quality by 3d reconstruction images were significantly higher than those by axial images (all P<0.05). Conclusion Spiral CT reconstruction can provide a reliable basis for clinical treatment decision-making and prognosis evaluation by providing intuitive and comprehensive diagnosis and treatment information.