Objective To investigate the value of three-dimensional CT reconstruction in the classification of femoral intertrochanteric fractures. Methods A total of 72 patients with femoral intertrochanteric fractures were collected. The images of X-ray and CT threedimensional reconstruction were read by three doctors separately. Fracture classification and stability assessment were performed according to the AO classification criteria. For cases with inconsistent results diagnosed by each physician based on X-ray and threedimensional CT reconstruction, a unified conclusion was drawn after discussion. For cases with unified conclusion based on X-ray which was inconsistent with that based on threedimensional CT reconstruction, a unified conclusion was drawn after discussion, and it was taken as the golden standard. The consistency of fracture classification performed by three physicians based on X-ray or three-dimensional CT reconstruction was analyzed, and the accuracy of fracture classification and stability assessment was compared between the two imaging methods. Results For AO subtypes, the kappa values of fracture AO classification by three physicians based on three-dimensional CT reconstruction were 0.49, 0.76 and 0.77, respectively, which were better than those of X-ray (0.26, 0.62, 0.51). The accuracy of fracture classification by three physicians based on three-dimensional CT reconstruction was significantly higher than that based on X-ray [90.28% (65/72) vs 44.44% (32/72)] (P<0.05). The proportion of unstable fractures diagnosed by the three physicians based on X-ray findings was significantly lower than that based on the golden standard [40.28% (29/72) vs 79.16% (57/72)] (P<0.05). The proportion of unstable fractures diagnosed by the three physicians based on three-dimensional CT was 77.78% (56/72), and there was no significant difference compared with the golden standard (P>0.05). Conclusion The three-dimensional CT reconstruction is superior to X-ray in the consistency, accuracy and evaluation of stability of intertrochanteric fractures.