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Over the past decades the development of fully implantable intramedullary extension nails has been advanced in the field of callus distraction. The Betzbone® (Medi-Tech GmbH - Betz Institute, Wadern, Germany), which we use is a further development of the Albizzia nail® and shows several advantages compared to other available implants. Especially the possibility of early loading capacity, even during the process of callus distraction, provides a higher patient comfort and significantly reduces subsequent and social costs. The following article discusses the basic principles of callus distraction and the necessary presurgical planning techniques. The surgical steps and the specific follow-up treatment for leg extensions with extension nails are described. Some clinical examples illustrate the possible applications. [ABSTRACT FROM AUTHOR]