Available level-I and level-II evidence has not demonstrated significant advantage from the use of bone grafts or bone graft substitutes to justify routine use in comminuted distal radius fractures in elderly for purpose of improved functional or clinical outcomes. All available evidence regarding the use of bone grafts or bone graft substitutes for treatment of comminuted distal radius fractures however is targeted at elderly patients. There is no available level I, II or III evidence regarding the use of bone grafts or bone graft substitutes for comminuted distal radius fractures or distal radius fractures with significant bone loss in younger patients. Due to the fact that bone graft substitutes may improve anatomical outcomes in selected populations, the use of bone graft substitutes for distal radius fractures in younger patients with significant metaphyseal bone loss could be considered. However, the use of autologous bone grafts is accompanied by a clinically important number of complications due to the harvesting from the donor site. This should be considered when treating a patient with comminuted distal radius fracture with significant metaphyseal bone loss, especially as satisfactory alternatives are available
