Background: Infrapatellar (IP) and suprapatellar (SP) surgical methods were used in this study to evaluate and analyse the clinical and functional results of distal tibia fractures treated with intramedullary nailing (IMN). Methods: 63 patients who received IMN treatment for distal fractures during June 2019-2022 were the subject of a retrospective investigation. The SP and IP procedures were used to perform IMN on a total of 27 and 36 patients, respectively. This study looked at the length of the procedure, blood loss, closed reduction rate, rate of adjuvant reduction technique, fracture healing time, and complications. The visual analogue scale was used to rate the severity of anterior knee discomfort. Clinical evaluations were conducted using the Lysholm Knee Scoring Assessment and the American Orthopaedic Foot and Ankle Society (AOFAS) scale. Results: A total of 63 patients were assessed, with a follow-up of 12 months. Between the two groups, there were no appreciable differences in terms of the typical operating time, blood loss, rate of adjuvant reduction technique, rate of closed reduction, fracture healing time, or Lysholm Knee Scoring Scale score. But in terms of pain score, AOFAS score, and fracture deformity rate, the SP technique outperformed the IP approach (P <0.05). Conclusions: The SP IMN technique is superior to the IP IMN technique for the treatment of distal tibia fractures in terms of functional result, reduction in knee discomfort, and reduction in fracture deformity.