Background: Tibial shaft fractures are one of the most common long bone injuries in adults, comprising approximately 37% of all such fractures. Extra-articular proximal tibial fractures represent 5–11% of these cases. Traditionally managed with casting and functional bracing, challenges such as patient discomfort and long-term joint stiffness have led to a shift towards intramedullary nailing (IMN). The suprapatellar approach for IMN offers potential benefits, including reduced anterior knee pain, improved fracture alignment, and enhanced functional outcomes compared to infrapatellar techniques. Materials and Methods: This prospective observational study was conducted at Pt. J.N.M. Medical College and Dr. B.R. Ambedkar Hospital, Raipur, from January 2023 to May 2024. A total of 25 patients with proximal third tibial fractures, aged 18–60 years, were included. Patients with compound fractures (Grade 3), intra-articular fractures, prior surgeries or trauma to the same limb, or pathological fractures were excluded. Suprapatellar IMN was performed using the expert tibia nail system. Functional outcomes were assessed using the Modified Lysholm score, anterior knee pain using the Visual Analog Scale (VAS), and radiological alignment through standard imaging. Follow-ups were conducted at 2 weeks, 6 weeks, 3 months, and 6 months. Results: The mean age of the participants was 37.6 years, with the highest incidence in the 31–40 age group (32%). Males constituted 76% of the cases. Road traffic accidents accounted for 88% of the injuries. Proximal third tibial fractures were the most common (72%), with segmental fractures comprising 28%. Functional outcomes showed 68% of patients achieving excellent results, 24% good, and 8% fair, with a mean Modified Lysholm score of 90.92. Radiological alignment was achieved in 92% of cases, with malalignment observed in 8%. Postoperative pain was minimal, with a mean VAS score of 0.32. Complications occurred in 16% of cases, including two infections (8%) and two cases of mal-reduction (8%). Conclusion: The suprapatellar approach for intramedullary nailing demonstrates excellent functional outcomes, minimal postoperative pain, and reliable fracture alignment in the treatment of proximal third tibial fractures. These findings suggest that this approach is a viable and effective option for managing such fractures. Further studies with larger sample sizes are warranted to validate these results and explore long-term outcomes.