This chapter discusses advances in Ilizarov surgery. As with every great advance in clinical medicine, Ilizarov’s principles were, at first, dismissed by most right-minded clinicians and researchers. The numerous components of Ilizarov’s apparatus were designed to meet specific requirements as the critical application of Ilizarov’s methods expanded. North American orthopedic surgeons were exposed to Ilizarov’s methods by Italian surgeons in the mid-1980s. As expected, North American surgeons made further modifications in the Ilizarov technique. Among the most useful of these modifications has been the fabrication of components of the Ilizarov apparatus from radiolucent carbon fiber. This chapter also discusses hybrid mountings, lengthening over an intramedullary nail, self-lengthening nail, and dangers of limb elongation, computerized distraction, and growth factors.