Tibial shaft fractures are conventionally treated with intramedullary nailing. The classical approach for intramedullary nailing with knee in 90 degree flexion, this challenges the surgeons in reduction and shortcomings of post-operative malalignment especially for proximally tibial shaft fractures due to quadriceps tendon pull. The advent of new suprapatellar approach with knee in semi-extended position overcomes this disadvantage. Since then lots of advancement in techniques and instrumentation has been developed for suprapatellar approach. The practice of accurate nail entry, reduction procedure, nail insertion and locking has shown good outcome. This article discuss about the pre requisites and surgical technical knowledge that we gained in our experience.