Ilizarov`s circular fixator initiated a new era in the field of extremity reconstruction and limb lengthening. Surgeons took over the superiority in the treatment of the deformities, limb length discrepancies, bone defects, and infections after distraction osteogenesis become popular in the world. Deformities could be treated with circular external fixator no matter what. The success rate has been increased and yet there is still a search for lower complication rates and better patient comfort. This resulted in the discovery and the use of new techniques in the field. Limb lengthening following the combined utilization of the fixators and intramedullary nails has been introduced to the daily practice especially for the treatment of multiapical deformities of the long bones due to metabolic and congenital diseases. In this review, fixator assisted nailing and consecutive lengthening over an intramedullary nail technique will be explained for both femur and tibia.