Objective To investigate the application value of three-dimensional reconstruction technique of multi-slice spiral CT and X-ray in the preoperative evaluation of scapular fractures. Methods 65 cases of patients with scapular fractures in the hospital were selected as the research objects. All of the patients underwent multi-slice spiral CT scanning, and the images were inputted to the workstation for 3D reconstruction and were compared with the results of x-ray examination. Results Among the 65 cases of fracture patients, there were 65 cases who were correctly diagnosed by 3D image reconstruction technique of multi-slice spiral CT. The fracture classification was consistent with that seen during operation and the accuracy rate was 100%. The correctly diagnosed cases of X-ray were 51cases and the accuracy rate was 78.46%. The diagnostic accuracy rate of 3D image reconstruction technique of multi-slice spiral CT was significantly higher than that of X-ray, and the difference was statistically significant (P<0.05). 3D image reconstruction technique of multi-slice spiral CT can clearly show the depression, displacement, the involved range and number of fractures. For non-comminuted fracture of unconspicuous displacement, it manifested as fracture line. When reexamined, the plates, condition of fixation and fracture recovery could be clearly observed. However, X-ray could not clearly show the fracture displacement and the degree of lesions. Conclusion 3D image reconstruction technique of multi-slice spiral CT is of high application value in the preoperative evaluation of scapular fractures.