Introduction: Bony deficits can be treated with approximation, grafting, and distraction osteogenesis. We have used Vitoss to fill in small bony deficits successfully. Due to its consistency, we have not used it in larger areas due to loss of shape. We present a patient with significant phalangeal bone loss in which Vitoss was used for bone replacement using an absorbable plate as scaffolding. Case: 52 y.o. male presented to the ER after injuring his index finger on a meat slicer. In the OR he had a bony defect of 2 x 3 cm on the mid-radial aspect of his index finger middle phalanx. The ulnar neurovascular bundle was intact. The wound was debrided and external fixation was performed. He was returned to the OR and the bony deficit was filled with Vitoss and an absorbable plate to create a scaffolding for the Vitoss. A groin flap was performed. Nine months post-operatively after flap separation, debulking and ex-fix removal the fracture is healed. Conclusion: Vitoss is useful in the treatment of fractures where bony tissue is lost. In areas where there's a large deficit, absorbable plates can create a mold for shaping and maintenance of the vitoss in the appropriate configuration.