Most structural health monitoring is carried out for a limited number of key measurement points of a bridge, and incomplete measurement data lead to incomplete mechanical equation inversion results, which is a key problem faced in bridge damage identification. The ability of digital images to holographically describe structural morphology can effectively alleviate the problem of damage identification due to incomplete test data. Based on digital image processing technology, a matrix similarity damage identification method based on a structural digital orthoimage was proposed. Firstly, a steel truss–concrete composite beam specimen with a complex support bar system was designed and fabricated in the laboratory, and the digital orthoimage of the test beam was obtained by the perspective transformation of the original image of the test beam. The body contour of the structure was extracted from the digital orthoimage of the test beam, and wavelet threshold denoising was performed on the lower edge profile to obtain the deflection curves of the structure under different working conditions. The verification results show that the maximum error of the deflection curve is 3.42%, which proves that the digital orthoimage can accurately and completely reflect the deformation of the structure. Finally, based on the digital orthophoto of the test beam, a matrix similarity test before and after the damage was carried out, and the results show that the singularities of the similarity distribution are consistent with the location of the damage; furthermore, the accurate positioning of the damage in different working conditions is achieved.