Objective To analyze the application value of X - ray and spiral CT 3D reconstruction in Lauge-Hansen classification diagnosis of ankle fracture. Methods 96 patients with ankle fractures who were admitted to the hospital from December 2016 to December 2017 were included in the study. All patients were examined by X-ray and spiral CT 3D reconstruction before operation. With results of intraoperative exploration and MRI examination as the golden standard, the accuracy in Lauge-Hansen classification diagnosis of ankle fracture was compared between X-ray and spiral CT 3D reconstruction. Results 45 cases of distal tibiofibular combined injuries were diagnosed by intraoperative exploration and preoperative MRI. The accuracy rate of X-ray diagnosis of distal tibiofibular combined injuries was significantly lower than that of spiral CT (62.22% vs 88.89%) (P<0.05). The sensitivity, specificity, accuracy and Kappa value of spiral CT for Lauge-Hansen classification were higher than those of X-ray. Conclusion Compared with X-ray, spiral CT 3D reconstruction has more advantages in Lauge-Hansen classification diagnosis of ankle fracture, and the accuracy is higher. X-ray can provide the basis for basic classification of most ankle fracture types. If X-ray examination shows questions or distal tibiofibular combined injuries, CT examination is needed.