Humeral fractures present unique challenges, particularly in cases involving segmental bone defects, nonunions, or complications from high-energy trauma. This chapter focuses on the application of vascularized bone grafts for the reconstruction of humeral defects, highlighting their role in restoring structural integrity and function. Vascularized bone grafts are particularly indicated for defects exceeding 6 cm, compromised local blood supply, or failed nonvascularized grafts. Options such as scapular, rib, iliac crest, medial femoral condyle, and fibula flaps are explored, with the fibula flap recognized as the preferred choice for long-segment defects due to its mechanical strength and reliable vascularity. For smaller defects, medial femoral condyle flaps are a valuable alternative. Key surgical techniques, including meticulous debridement, defect preparation, graft fixation, and vascular anastomoses, are described to optimize outcomes and minimize complications. The chapter emphasizes the importance of preoperative assessment, infection control, and careful planning to ensure graft viability and promote union. In summary, we provide comprehensive information on humeral fractures, and various vascularized bone graft options for treatment, emphasizing the importance of careful patient evaluation and surgical technique selection.