Background: Extra-articular proximal tibial fractures present significant management challenges due to metaphyseal anatomy, deforming forces, and limited soft tissue coverage. Suprapatellar intramedullary nailing (SPN-IMN) has emerged as a minimally invasive technique aimed at improving alignment and functional outcomes. Methods: This prospective observational study was conducted on 25 patients with extra-articular proximal tibial fractures treated with SPN-IMN at a tertiary care center over 18 months. Patients aged 20–50 years with closed or Gustilo-Anderson Grade I open fractures were included. Functional outcomes were assessed using the Knee Society Score (KSS), and radiological outcomes were evaluated based on alignment and callus formation. Patients were followed up at 1, 3, 6, and 9 months. Results: The majority of patients were young males, with road traffic accidents being the most common mechanism of injury (88%). Functional outcomes improved progressively, with mean KSS increasing from 63.00 at 1 month to 85.12 at 9 months. At final follow-up, 72% of patients achieved excellent results. Radiological assessment showed satisfactory alignment in 80% of cases. Complications were minimal, with superficial infection in 8%, deep infection in 4%, malunion in 16%, and nonunion in 8%. Early weight bearing (mean 2.92 weeks) and good knee range of motion (mean 125.64°) were observed. Conclusion: SPN-IMN is an effective and minimally invasive technique for extra-articular proximal tibial fractures, providing good functional recovery, satisfactory alignment, and low complication rates.