Introduction: The __ampersandsignldquo;fractures of the shaft__ampersandsignrdquo; of the tibia are the most common fractures among the long bone fracture. Various approaches to intramedullary nailing have been proposed. Pain in the anterior region of the knee is the very common complication of intramedullary nailing procedures. Although all techniques for nail insertion have been proven feasible, a correlation of Pain in the anterior region of the knee and functional outcome is lacking between the trans patellar and medial parapatellar techniques. Aim: To compare functional outcome in both the approaches of trans patellar and medial parapatellar techniques for the tibial fracture treatment. Materials and Methodology: After a detailed clinical examination __ampersandsignamp; detailed history were taken among 60 subjects divided into two groups of splitting and sparring groups. Between two groups compared to age, sex, cause of the injury, __ampersandsignldquo;open/ closed types of injury__ampersandsignrdquo;, side of injury, time of union, anterior knee pain, range of motion. Results: No statistically significant values were observed among the two groups when the age, sex, mode of injury, sides, type of injury, time of union were compared. Statistically significant values were observed when the anterior knee pain, range of mo tion were compared between the group. Conclusion: Medial parapatellar technique was efficient in treating the tibial fracture than the trans patellar splitting technique in the present study.