Background: Tibial shaft fractures are among the most common long bone fractures encountered in orthopaedic trauma, accounting for a significant portion of hospitaladmissions related to musculoskeletal injuries. The current study aims to compare the functional and radiological outcomes of intramedullary nailing (IMN) and external fixation (EF) in the management of tibial shaft fractures.Material and Methods: A total of 140 patients with tibial shaft fractures (Gustilo-Anderson type I or II) were randomized into two equal groups: 70 patients treated with IMN and 70with EF. Functional outcomes were assessed using the American Orthopaedic Foot andAnkle Society(AOFAS) score andthe Lower ExtremityFunctionalScale (LEFS) at 3, 6, and 12 months. Radiological outcomes included time to union, malalignment, non-union, and delayed union. Complications such as infection, hardware failure, and reoperations were also evaluated. Data were analyzed using SPSS 25.0, with p-values <0.05 considered statistically significant.Results:IMN demonstrated significantly better functional outcomes, with AOFAS and LEFS scores at 12 months of 91.56 ± 5.21 and 88.21 ± 5.12, respectively, compared to 82.43 ± 6.89 and 74.98 ± 6.34 for EF (p < 0.001). Radiologically, IMN resulted in faster union (18.67 ± 2.12 weeks vs. 20.78 ± 2.45 weeks, p < 0.001). Complication rates were lower in the IMN group, with infection rates of 4.29% versus 17.14% in EF (p = 0.014) and reoperation rates of 5.71% versus 15.71% (p = 0.048). Patient satisfaction was higher in the IMN group (90.00% vs. 77.14%, p = 0.038), and a significantly greater proportion returned to work by 12 months (88.57% vs. 71.43%, p = 0.010).Conclusion: intramedullary nailing (IMN) is superior to external fixation (EF) in the management of tibial shaft fractures, demonstrating better functional and radiological outcomes, fewer complications, and higher patient satisfaction. EF remains a valuable option in cases with extensive soft tissue injury, but its limitations highlight the need for careful patient selection.