Introduction: Intramedullary nailing is a commonly employed procedure for treating distal tibial fractures. The two primary approaches for this procedure include the suprapatellar and infrapatellar techniques. Despite their widespread use, there is ongoing debate about the relative merits and drawbacks of these two approaches. Aim of the Study: The aim of this study was to assess the comparison between suprapatellar and infrapatellar approaches for intramedullary nailing of distal tibial fractures. Methods: This cross-sectional study was conducted in Department of Orthopaedics Surgery, Brahmanbaria Medical College Hospital, Brahmanbaria, Bangladesh, during the period from December 2020 to December 2022. Total 120 patients with intramedullary nailing of distal tibial fractures were included in this study. All the patients were divided into two groups; Group A comprised of 60 patients treated by suprapatellar approach and Group B comprised of patients treated by infrapatellar approaches. Result: For age, the mean age in Group A is 42.3 years (SD± 9.8 years), and in Group B it is 44.7 years (SD±10.3 years). In terms of sex, male predominance was seen in both groups. Surgical characteristics like surgical time (68.5 vs 74.2 mins), blood loss (58.4 vs 63.7 ml), and fluoroscopy number (15.7 vs 18.9) were significantly less in Group A. Post-operatively, Group B reported more pain (VAS score: 27.1 vs 18.7), while Group A had better range of motion (18.3 vs 17.1) and knee functionality (Lysholm score: 84.6 vs 80.9). Group B showed better foot and ankle functionality (AOFAS score: 94.4 vs 91.3). Fracture healing time was similar (24.5 vs 24.7 months). Fewer patients in Group A experienced complications like fracture deformity, malalignment, and surgical site infections. Conclusion: The suprapatellar approach may be the preferred nailing technique for treating distal tibial fractures compared with infrapatellar approach.