Objective: To compare two insertion techniques of intramedullary interlocking nails (medial parapatellar versus intrapatellar insertion) in patients with tibial fractures. Methodology: This study was performed at Al-Kindy Teaching Hospital from August 2020 until March 2022. All 32 patients with tibial fractures (29 males and 3 females) were included for tibial closed nail fixation and then followed up for 6 months. We categorized these patients into two groups; Group A (16 patients), those treated by medial parapatellar insertion of an interlocking nail, and Group B (16 patients) with transpatellar tibial nail insertion. All patients were treated by the same surgical team. Results: The range of movement in two weeks (from extension to flexion) was up to 30°. At the end of the follow-up period, all patients in Group A had functional flexion greater than 90°, whereas three patients in Group B had limited flexion that necessitated scheduled physical therapy. Regarding the functional outcome, in group A patients and in group B patients, the mean International Knee Documentation Committee score demonstrated a better outcome in patients with medial parapatellar insertion than those in group B. According to the visual analysis score, the transpatellar insertion demonstrated more discomfort than that in the paramedial insertion group, both clinically and statistically. Conclusion: Medial entry point in intra medullary tibial nailing had less anterior knee pain in post-operative follow up.