[Abstract] Objective:Compare the nail treatmentments of tibial shaft fracture through the suprapatellar and infrapatellar approach.Methods: 62 cases of tibial shaft fracture treated with intramedullary nail from June 2012 to June 2019. 30 cases with suprapatellar approach and 32 cases with infrapatellar approach. The perioperative, follow-up and radiographic data were compared between the two groups. Results: All cases followed up for 12-18 months with a mean of (14.30±2.50) months. The operation time, fluoroscopy times and incision length of suprapatellar group were less than those of infrapatellar group (P<0.05). No significant difference in blood loss between the groups (P > 0.05). In the subpatellar group, 1 case with anterior knee pain and 1 case with external rotation deformity. In suprapatellar group, 1 case with delayed union. No significant difference between the groups of weight-bearing time and knee motion(P>0.05). Lysholm-knee score of the suprapatellar group was better than that of the infrapatellar group, and the score of 12 months was higher than that of 6 months (P< 0.05). No significant difference of fracture healing time, coronal displacement and angulation between the groups(P>0.05).But significant differences of sagittal displacement and angulation (P<0.05). Conclusion: The suprapatellar approach is beneficial for fracture reduction and functional recovery. The infrapatellar approach is good for the exposure of the nail enter point.Both approaches are suitable for tibial intramedullary nailing.