Objective: To compare the efficacy and complications of tibial intramedullary nail in the treatment of tibial fracture by suprapatellar approach and infrapatellar approach. Methods: The data of 63 patients with tibial fractures treated with intramedullary nail in our ospital from 2017 to 2018 were retrospectively analyzed. The operative time, amount of bleeding,hospital from 2017 to 2018 were retrospectively analyzed. The operative time, amount of bleeding, fracture healing, incidence of malunion, incidence of infection, postoperative knee pain score and Lysholm knee function score were compared between suprapatellar approach and infrapatellar approach. Results: Of all 63 patients，there were 30 cases of suprapatellar approach, 33 cases of infrapatellar approach.An average follow-up of 14.4 months. The mean operative time of supratellar approach group (85.6±25.6min) was significantly shorter than that of infrapatellar approach group (115.6±42.8min), the difference was statistically significant (P = 0.002). 1 year after surgery, the NRS score of knee pain in the suprapatellar approach group (mean 2.3 points) was lower than that of the infrapatellar approach group (mean 3.2 points), difference was statistically significant (P = 0.020).1 year after surgery, Lysholm knee function score of suprapatellar approach group (mean 85.76 points) was significantly higher than that of infrapatellar approach group (mean 74.99 points), and the difference was statistically significant (P=0.021). There were no statistically significant differences in intraoperative blood loss, infection rate, fracture healing rate or fracture malunion rate between the two groups (P＞0.05). Conclusion: Suprapatellar approach intramedullary nail treatment for tibial fracture can reduce the operation time, reduce postoperative anterior knee pain, and improve postoperative knee joint function. This surgical approach has the advantages of minimally invasive surgery, relatively simple operation, convenient fluoroscopy, exact curative effect, and fewer postoperative complications, and is a good choice for the treatment of tibial fracture.