94 patients with proximal-third tibial shaft fractures were selected for the purpose of comparing the semi-extended suprapatellar incision approach and the conventional medial parapatellar surgical approach. Outcomes included in terms of guidewire and intramedullary nail alignment. The results indicated no significant differences in guidewire alignment between groups, but significant improvement in overall alignment of the intramedullary nail in the coronal and sagittal planes with the semi-extended parapatellar approach, as well as significantly improved final position of proximal end of the intramedullary nail.