Ninety-four patients with tibial fractures scheduled for an intramedullary nail fixation procedure were randomized to receive the procedure via a suprapatellar approach or infrapatellar approach. The primary outcome of interest was weightbearing ratio between the injured/uninjured limb as measured by the Aberdeen Weight-bearing Test for the Knee (AWT-K). Secondary outcomes of interest included the Irrgang Knee Outcome Symptom, Function and Total scores, the Lysholm score, and pain on a Visual Analog Scale (VAS). Follow up was performed at 4 months, 6 months and 12 months post-operation. Results revealed significantly favourable weight-bearing ratios in the suprapatellar group compared to the infrapatellar group at 4 months post-operation. Furthermore, 12 month Lysholm scores were significantly in favour of the suprapatellar group. Otherwise, no significant differences were observed in the outcomes of interest.