Fifty-eight adult patients with extra-articular proximal tibial fractures were randomized to receive fixation with either an intramedullary nail (IMN) or proximal tibial plate (PTP) technique in order to compare the clinical efficacy of the two techniques. Intramedullary nailing resulted in shorter hospital stay and time until union when compared to the use of a proximal tibial plate. No significant differences in knee range of motion, malalignment in the coronal or sagittal plane or rate of nonunion and infection were observed between groups, suggesting that intramedullary nailing may be superior due to the observed acceleration in recovery.