Sixty-two patients with extra-articular proximal tibial fractures were enrolled in a randomized prospective clinical study conducted between May 2024 and December 2024. Fourteen patients were lost to follow-up, leaving 48 patients for final analysis. Participants were randomized to receive intramedullary nailing (IMN) or proximal tibial plating (PTP). The primary outcomes of interest included duration of hospital stay, fracture union time, time to full weight bearing, infection rate, malalignment, knee range of motion, and rates of non-union or delayed union. Patients were followed for up to a year. Overall, the results of the study revealed that IMN was associated with significantly shorter hospital stay, faster fracture union, and earlier full weight bearing compared with PTP. No statistically significant differences were observed between groups for operative time, infection rate, knee range of motion, or malunion and non-union rates. These findings suggest that IMN provides earlier recovery advantages while maintaining comparable complication rates.