Purpose <p>Tibial open shaft fractures are very common and susceptible to infection, which can lead to significant morbidity especially infection and non-union. Antibiotic coated nail is one option for fixing open shaft tibial fractures to minimise infection. This study aimed to compare the clinical outcome of Gentamicin-coated tibial nails versus regular unreamed interlocking tibial nails in the treatment of type I and II tibial open fractures.</p> Methods <p>Between 2013 and 2020, in a retrospective study of 124 patients with Gustilo type I and II tibial fractures compared non-antibiotic-coated nails (62 patients) with gentamicin-coated nails (62 patients) over 12 months. This study assessed infection rates, duration of hospital stays, fracture union time, and complications.</p> Results <p>The antibiotic nail group had significantly lower postoperative infection rates (3.2%) than the regular nail group (17.7%), (χ2 = 4.64, <i>p</i> = 0.031). At the 6-month follow-up, significant differences were observed in ESR (<i>p</i> = 0.031), CRP (<i>p</i> = 0.019), leukocyte count (<i>p</i> = 0.0241), and blood culture (<i>p</i> = 0.018), but not in hemoglobin levels (<i>p</i> = 0.067). The Gentamicin-coated nail group demonstrated better fracture union rates at 6 and 12 months, (<i>p</i> = 0.0267) and lower overall complication rates.</p> Conclusion <p>A tibial nail coated with Gentamicin is an effective method for preventing infection in type I and II open fracture shafts of the tibia. It allows, shortens hospital stay and healing time, prevents infection, and thus reduces the chance of a second surgery.</p> Level of evidence <p>Level III, a retrospective study.</p> Design <p>Retrospective analytical study.</p> Hypothesis <p>We hypothesized that Gentamicin-coated nail is effective in preventing infection in Gustilo type I and II open fractures compared to non-antibiotic-coated regular nails.</p>