Bone grafting in the upper extremity is an important consideration in patients with injuries or conditions resulting in missing bone stock. A variety of indications can necessitate bone grafting in the upper extremity, including fractures with acute bone loss, nonunions, malunions, bony lesions, and bone loss after osteomyelitis. Selecting the appropriate bone graft option for the specific consideration is important to ensure optimal patient outcomes. Considerations such as donor site morbidity and the amount and characteristics of bone graft needed all weigh in the decision making regarding which type of bone graft to use. This article reviews the options available for bone grafting in the upper extremity.