Tibial shaft fractures are among the most common long bone fractures, requiring effective stabilization for optimal healing and functional recovery. Intramedullary (IM) nailing and plate fixation represent two widely used surgical approaches, but their comparative effectiveness in terms of union rates, functional outcomes, and complication rates remains a topic of debate. This randomized controlled trial (RCT) evaluates the clinical outcomes of IM nailing versus plate fixation in tibial shaft fractures. A total of 200 patients with closed or open Gustilo-Anderson type I-II tibial shaft fractures were randomly assigned to IM nailing (n=100) or plate fixation (n=100). The primary outcome was fracture union time, assessed radiologically and clinically over 12 months. Secondary outcomes included functional recovery using the American Orthopaedic Foot and Ankle Society (AOFAS) score, complication rates (infection), and reoperation rates. IM nailing demonstrated a significantly shorter union time (16.2 ± 3.5 weeks vs. 20.8 ± 4.1 weeks, p<0.001), superior functional recovery at six months (p=0.02), and lower infection rates (p=0.04) compared to plate fixation. However, malalignment occurred more frequently in the IM nail group (12% vs. 4%, p=0.03). Plate fixation was associated with increased surgical time (p=0.01) and a higher risk of hardware failure. These findings highlight the efficacy of IM nailing in reducing healing time and improving functional outcomes, with a lower risk of infection. However, the increased risk of malalignment warrants consideration. Future studies should focus on optimizing fixation techniques to balance these outcomes.