Twelve open fractures with segmental bone loss have been treated with primary corticocancellous bone graft in eight patients who suffered severe traumatic open injuries in the hand. All of the patients were male with an average age of 39 years. Average follow up was 14 months (one patient was excluded due to lack of proper follow up). Mechanism of injury included crush and degloving. All of our patients suffered either multiple finger or metacarpal fractures with several associate injuries in the hand. Bone graft was harvested from the iliac crest in six cases and distal radius in one case. Extensive primary debridement was performed prior to bone grafting. Type of fixation included miniplate, condylar plate, Kirschner wires and/or cerclage. Eleven out of the twelve fractures healed primarily in an average time of 3 months. None of the patients had an infection. Some of the complications were severe stiffness and contracture including 2 secondary revision of amputation. Most of these complications were found in direct relation with the associate injuries. An important variation in the final range of motion was related with the severity of the injury. The average time to return to regular work was 5 months. We conclude that immediate corticocancellous bone graft in one stage reconstruction is a procedure of choice for segmental bone defects of the hand. The risk of infection is not a contraindication for this procedure.