Nail bed trauma is a commonly overlooked part of fingertip reconstruction. To evaluate outcomes of nail bed injuries treated with different reconstructive techniques. We conducted a retrospective chart review of 76 patients who underwent nail bed reconstructions due to trauma between January 2000 and August 2017. In our series, 32 patients (42.10%) underwent suturing of the nail bed (SNB)+ 25 patients (32.89%) underwent suturing of the nail bed associated with an osteosynthesis of the distal phalanx (SNBOst)+ 19 (25%) received a nail bed graft in the ER (NBGE). Outcomes assessed were growth (0=no growth+ 1=partial growth+ 2=normal growth), size (0=less than 25%+ 1=between 25 and 50% and 2=>50% of the size of the contralateral nail) and shape (0=significant deformity on the horizontal and vertical planes+ 1=vertical deformity, 2=no deformity) of the nail compared to the contralateral finger. The results obtained by the sum of scores were classified as good (5–6), acceptable (3–4) and poor as previously described by Foucher et al. Were assessed in patients with at least 12 months of follow-up. The results were considered “good” in all patients who underwent SNB and in those who underwent SNBOst associated with an osteosynthesis of the distal phalanx. “Good” results were also achieved in 57.9% of patients who underwent NBGE. “Acceptable” results were obtained in 42.1% of patients grafted in the ER. In a British study (Mignemi et al.) of 46 pediatric nail bed lacerations, simple suturing with either Vicryl-Rapide or PDS associated with nail replacement as a splint resulted in high patient parent satisfaction. A recent retrospective study (Weinand et al.) of 401 patients showed fewer nail deformities in patients with nail trauma (344 compression injuries, 44 amputations and 13 avulsion injuries) treated with native nail splints as compared to silicone splinting. In our series, patients treated with simple suturing of the nail bed—both those with and without associated finger fractures—and patients who underwent reconstruction of the entire nail bed showed improved outcomes compared to those treated with nail bed grafts.