Objective: To investigate the clinical effect of intramedullary nail fixation through infrapatellar approach and suprapatellar approach in the treatment of tibial fractures. Methods: PubMed, EMBASE, Cochrane Library, Wanfang database, Weipu database and CNKI were searched. The relevant literature on suprapatellar and infrapatellar intramedullary fixation for the treatment of tibial fractures published in August 2021 was searched. The inclusion and exclusion criteria of the literature were formulated. The binary variables in the literature were analyzed by Review Manager 5.3 software (fracture malunion, fracture nonunion, postoperative infection) and continuous variables (operation time, intraoperative bleeding, location of needle entry point, radiation dose, VAS score and Lysholm score) were analyzed respectively. Results: 13 literatures were included in the study, including 1112 cases of tibial fracture. In fracture malunion (OR = 5.43, 95% CI: 2.16, 13.65), accurate nail placement (MD = 1.74, 95% CI: 1.22, 2.27) (MD = 2.25, 95% CI: 1.35, 3.16), postoperative pain score (MD = 0.81, 95% CI: 0.64, 0.98) and knee function (MD = -5.26, 95% CI: - 6.52, - 4.00) the suprapatellar approach was better than the infrapatellar approach, while the two groups were better in fracture nonunion (OR = 0.95, 95% CI: 0.55, 1.65) and postoperative infection (OR = 0.62, 95% CI: 0.25, 1.57) Intraoperative bleeding (MD = 0.18, 95% CI: - 1.71, 2.07), intraoperative radiation dose (MD = 8.72, 95% CI: - 6.24, 23.68). Conclusion: the suprapatellar approach is superior to the infrapatellar approach in reducing fracture malunion, improving accurate nail placement, reducing postoperative pain and restoring knee function, especially in the treatment of proximal and distal tibial fractures, but there is no significant difference in fracture healing, intraoperative bleeding and complications The two approaches can cure tibial fractures well.