This study was performed to compare the respective therapeutic effects and related factors of intramedullary nailing with adjunct plate and intramedullary nailing with blocking screw options in proximal tibia extra-articular fractures.Materials and methods This randomized prospective clinical study was conducted on 36 skeletally mature patients of the proximal tibia treated with intramedullary nailing with adjunct plate or intramedullary nailing with blocking screw by trained surgeons at a trauma center. 19 patients with proximal tibial extra-articular fractures were treated with traditional approach intramedullary nails with adjunct plates: 13 males and 6 females; aged 18-72 years, mean (34.10±15.30) years old.Injury factors: 13 cases of traffic injuries, 6 cases of fall from height; fractures according to AO classification: 10 cases of AO41-A2 type, 9 cases of AO41-A3 type. Blocking nail technique was used in 17 cases, 9 males and 8 females; aged 19-55 years old, average (36.90±12.80) years old; injury factors: 15 cases of traffic injuries, 2 cases of falls from high places; fractures according to AO classification There were 14 cases of AO41-A2 and 3 cases of AO41-A3. The average length of hospital stay, operative time, intraoperative fluoroscopy, infection rate, fracture healing time, knee motion range, postoperative rupture angle, knee pain, and surgical consumables were compared between the two groups. The last follow-up was based on Johner-Wruhs. Evaluation of curative effect after postoperative evaluation of humeral shaft fracture. Results There were no significant differences in the infection rate, fracture healing time, and knee joint range between the two groups (P > 0.05). There were significant differences in mean hospitalization time, operation time, intraoperative fluoroscopy, postoperative angulation deformity, knee pain, surgical consumables cost, and Johner-Wruhs score (P < 0.05)..Conclusion Both implants have shown promising results in extra-articular proximal tibial fractures. The first needs additional surgical incision and material, the second needs special surgical technique. Although the frist one’s operation time, intraoperative fluoroscopy time, and degrees of malalignment and implate’s fee were low, the average fee of implates and Postoperative hospital stay were higher, and the second one was the opposite, Both patients had complications of anterior knee pain, and the plate group was slightly higher than the block group. Although it was improved after the internal fixation and removal, it is worthy of attention of clinicians..