Background: Tibia and fibula shaft fractures are pervasive, constituting the lion's share of long bone injuries in adults. Tibial shaft fractures, making up about 2% of all fractures, often necessitate surgical intervention. While the traditional infra-patellar approach for intramedullary nail fixation is commonplace, it encounters challenges in proximal third tibia shaft fractures, resulting in deformities and persistent postoperative knee pain. The use of suprapatellar intramedullary nail fixation to treat tibial shaft fractures has grown in acceptance and interest. Therefore, the purpose of the current study was to evaluate and compare the clinical, functional and radiological union and complications in fractures of shaft of tibia nailing with supra-patellar approach and infrapatellar approach.

Materials and Methods: The present prospective and comparative clinical study was conducted for a period of 2 years on 40 patients with tibial shaft fractures admitted under the Department of Orthopaedics, SSIMS and RC, Davangere. All the patients who fulfilled inclusion criteria were eligible for the study. After obtaining physical fitness for surgery, the subjects were surgically managed with intramedullary nailing either through suprapatellar approach or infrapatellar approach. The outcome was assessed based on Lysholm score, Lower extremity functional scale and Klemm’s and Borner’s criteria.

Results: The average time of fracture healing was comparable in both the Suprapatellar nailing (SPN) and Infrapatellar nailing (IPN) groups i.e ~17weeks. Anterior knee pain was noted in 26.31% of the IPN group whereas it was nil in the SPN group which was statistically significant (p < 0.05). Excellent results were observed in 42.10% of IPN cases, whereas 60% of SPN cases showed excellent outcomes according to Klemm’s criteria.