【Objective】 To evaluate the ability of dual-energy subtraction (DES) with direct digital radiography (DR) for diagnosis rib fracture. 【Methods】 To collect the data of 87 patients who had undergone dual-energy subtraction radiography and considered with their clinical data

58 of them have rib fracture that is confirmed by CT or rechecking; and 29 cases did not have any rib fracture. Two senior radiologists evaluate the standard DR images and the DES images by double blind method

and tell the situation of rib fracture.【Results】 There is no prominent difference between the DES bone images and the standard DR images

but DES bone images could detect more rib fracture in same special location (armpit section and under diaphragm). The detection of different forms of fracture is different

for the complete fracture

the detection rate of fracture for the DES images and standard DR images was 93.9% and 84.1%

the difference was statistically significant. For incomplete fracture

the detection rate of fracture between the two did not differ significantly. Surprisingly

the positive rate of cases with associated chest injury is similar in these images. 【Conclusion】 Dual-energy subtraction radiography technique can separate the bone and soft tissue

and the standard images

soft tissue and bone tissue images are obtained. Dual-energy subtraction technique can eliminate the influence of soft tissue effectually

then get a pure bone tissue image

which is superior to the standard DR images on detecting rib fracture. It can show fracture line and bone change more clearly. Dual-energy subtraction images can act as an effective complement for the standard DR images.