Cracking in concrete box girder bridges will have a significant impact on the safety and durability of the structure, and many box girder bridges which are in service have undergone varying degrees of cracking. Currently, the safety design of actual bridge projects place an emphasis on the stress or the load value of a cross section at the limit value specified in the code for safety control. This design method assumes that the member itself is of uniform and continuous material and is internally undamaged. However, the bridge structure is more or less cracked to varying degrees during the period from casting to construction to operation of the concrete members. In this paper, a finite element computational model of a three-span prestressed concrete box girder bridge with existing cracks is established based on the fracture mechanics theory, and the critical parameters of crack extension are introduced to evaluate the extension state of cracks. At the same time, the extended stability of the existing cracks of the box girder bridge is analyzed by considering the temperature effect, vehicle loading, and prestressing loss, and the sensitivity of crack extension under each working condition is investigated. The results show that, with the increase in crack length and depth, the crack expansion is promoted, but the effect is relatively small, and the maximum stress intensity factor is only 6.48 MPa mm1/2. Under the multi-factor coupling effect, the cracks show a composite crack expansion dominated by type I cracks, the longitudinal cracks of the existing base plate are in a stable state, the maximum value of the crack expansion critical parameter of the vertical cracks of the webs reaches 1.087, and there is a tendency to expand locally. The maximum value of the critical parameter for crack extension of the vertical crack in the web plate reaches 1.087, and there is a tendency towards local expansion. The crack extension evaluation criteria proposed in this paper have a certain reference value for crack extension research on similar concrete box girder bridges and provide a scientific basis for the optimized design of similar bridges.