Objective To explore the application of multi-slice spiral CT (MSCT) axial scanning combined with coronal and sagittal multi-planar reconstruction (MPR) images in the diagnosis of thoracic fractures. Methods The routine axial CT images, coronal and sagittal MPR images of 35 patients with pathologically confirmed thoracic fractures who were admitted in our hospital between May 2012 and May 2013 were analyzed retrospectively. Based on the results of pathological examination, the type and detection rate of the thoracic fractures were observed. All patients with thoracic fractures underwent examination for chest trauma. Results Among the 35 patients with thoracic fractures, there were 7 cases with oblique fractures, 27 cases with transverse fractures, 3 cases with comminuted fractures, 11 cases with dislocation fractures, 23 cases with non-dislocation fractures, 10 cases with dislocation transverse fractures and 20 cases with non-dislocation transverse fractures. Routine axial CT detected 25 cases with thoracic fractures, and the detection rate was 71.43%. There was missed diagnosed patients among patients with oblique fractures, transverse fractures, non-dislocation fractures and non-dislocation transverse fractures. Combined with coronal MPR images, the missed diagnosis of oblique fractures can be avoided. Sagittal MPR can clearly display various types of fractures, and the detection rate was 100%. The routine axial CT found that there were 6 cases complicated with vertebral fractures,19 cases with multiple rib fractures, 4 cases with fracture of the clavicle, 20 cases with pleural effusion, 9 cases with substernal mediastinal hematoma, 3 cases with retrosternal mediastinal emphysema and 18 cases with pulmonary contusion. After combination of coronal and sagittal MPR images, 7 cases with posterior mediastinal hematoma were found (missed diagnosed by axial CT). Conclusion MSCT axial scan combined with coronaland sagittal MPR images can effectively improve the detection rate of various types of fractures, especially sagittal MPR can avoid missed diagnosis of transverse fractures, non-dislocation fractures and non-dislocation transverse fractures, with high clinical application value.