The choice between allograft or demineralized bone matrix is not unambiguous in trauma surgery

•Allografts and demineralised bone matrix are widely used for fracture surgery.•This study evaluated the difference between allogeneic allograft or DBM as a bone substitute in trauma surgery.•The efficacy, clinical evidence, safety, cost, and patient acceptance were evaluated.•It is not possible to definitively conclude whether it makes a difference if allograft or DBM is used in trauma surgery.•This article informs the surgeons choice of allograft or DBM. In fracture surgery, large bone defects and non-unions often require bone transplantation, and alternatives to autograft bone substitutes in the form of allografts from bone banks and the derivate demineralised bone matrix (DBM) are widely used. With a focus on efficacy, clinical evidence, safety, cost, and patient acceptance, this review evaluated the difference between allogeneic allograft or DBM as a bone substitute in trauma surgery. The efficacy in supporting bone healing from allograft and DBM is highly influenced by donor characteristics and graft processing. Mechanical stability is achieved from a structural graft. Based on the existing literature it is difficult to identify where DBM is useful in trauma surgery, and the level of evidence for the relevant use of allograft bone in trauma is low. The risk of transmitting diseases is negligible, and the lowest risk is from DBM due to the extensive processing procedures. A cost comparison showed that DBM is significantly more expensive. The experiences of dental patients have shown that many patients do not want to receive allografts as a bone substitute. It is not possible to definitively conclude whether it makes a difference if allograft or DBM is used in trauma surgery. It is ultimately the surgeon's individual choice, but this article may be useful in providing considerations before a decision is made.