Proper management of nail bed lacerations and fingertip avulsions requires careful evaluation, including assessment for associated injuries and plain radiographs, prior to definitive care. There are various presentations of fingertip injuries that may end up with post-traumatic fingertip amputation; laceration, Subungual hematoma, or even Finger amputation. Anterior-posterior (AP) and true lateral plain radiographs of the affected finger and, for amputations with possible loss of bone, any intact amputated tissue, are necessary before repair of a fingertips laceration or fingertip amputation. The three main goals of treatment are the restoration of sensation and durability in the tip and assuring proper bone support to allow for nail growth. Simple lacerations of the nail bed can be managed by suturing the damaged structures, and this procedure can be done in an emergency department setting. Avulsion or severe crush finger injuries may require grafting for optimum outcome. Tuft fractures are commonly associated with nail bed lacerations which can often be managed with the repair of the nail bed and surrounding structures. Trephination (bur hole to relieve pressure) is recommended for all hematomas without disruption of the nail matrix. The majority of fingertip losses are adequately treated with VY advancement and cross-finger flaps. To minimize loss of bone support and fingertip length, a vascularized bone graft can be obtained as part of a VY flap to reconstruct the fingertip while preserving length. Moberg flap is a good choice providing sensate glabrous tissue for volar oblique defects measuring up to 2 cm over the distal third of the thumb.