The use of allograft bone in the hand was pioneered by Smith and Mankin. They report on the use of allogenic bone to replace the distal radius following excision of giant cell tumors in 1977. Since then the allograft bone has been used to reconstruct metacarpal defects following severe trauma from crush injuries and gunshot wounds. The allogenic bone is useful in treating injuries with loss of multiple segments of metacarpals since the allograft consists of cortical bone which can be firmly stabilized with internal fixation to allow for early motion. Following thumb or multiple finger amputation, hand reconstruction can be performed using two-stage distraction lengthening followed by grafting with allogenic bone. Allograft bone with articular cartilage can be useful as a hemijoint replacement in treating injuries that severely damage the metacarpal head. There are possible disadvantages associated with allografts, such as increased risk of infection or delayed union, but these concerns can be minimized with proper bone banking methodology. Unlike autogenous grafts, allografts have no donor site morbidity and a near anatomic match of the absent bone segment is feasible.