Traditionally, tibial shaft fractures have been fixed with intramedullary nailing using an infrapatellar technique. A suprapatellar technique has been used more recently, but the optimal approach is unknown. A randomized controlled trial was performed comparing suprapatellar to infrapatellar nailing was performed in 45 patients. Outcomes included alignment and operative time. The investigators found that suprapatellar nailing resulted in faster operative times with no difference in overall alignment. Overall, suprapatellar nailing may at the very least offer the advantage of shorter operative time, though it is unclear which approach the surgeons were more experienced with.