Steel's 1973 paper describes the triple innominate osteotomy — simultaneous cuts through the ilium, ischium, and pubis — for hip dysplasia in patients aged 7–17. It was designed for cases where Salter and Pemberton osteotomies could not achieve adequate correction. The paper reports technique and outcomes across 52 procedures with up to 10 years of follow-up.
When a teenager with severe hip dysplasia has an acetabulum too deficient for a Salter or Pemberton osteotomy, the Steel triple innominate osteotomy is the next step in the reconstructive ladder.
Cutting all three pelvic bones frees the acetabulum completely, enabling correction magnitudes that single-bone procedures cannot reach. The 77% satisfactory rate in this series established the procedure as safe and effective for this indication.
Patient selection is the critical variable. Neuromuscular conditions (myelodysplasia, cerebral palsy, peroneal atrophy) account for most failures — muscle imbalance and spasticity persist after the bony correction and undermine the result.
Modern practice has built on Steel's foundation by adding attention to the degree of correction, fragment vascularity, and concurrent labral pathology. Knowing this hierarchy. Salter, Pemberton, then Steel. Is essential for pelvic osteotomy questions on the OITE.
Steel's 1973 paper describes the triple innominate osteotomy — simultaneous cuts through the ilium, ischium, and pubis — for hip dysplasia in patients aged 7–17. It was designed for cases where Salter and Pemberton osteotomies could not achieve adequate correction. The paper reports technique and outcomes across 52 procedures with up to 10 years of follow-up.
When a teenager with severe hip dysplasia has an acetabulum too deficient for a Salter or Pemberton osteotomy, the Steel triple innominate osteotomy is the next step in the reconstructive ladder.
Cutting all three pelvic bones frees the acetabulum completely, enabling correction magnitudes that single-bone procedures cannot reach. The 77% satisfactory rate in this series established the procedure as safe and effective for this indication.
Patient selection is the critical variable. Neuromuscular conditions (myelodysplasia, cerebral palsy, peroneal atrophy) account for most failures — muscle imbalance and spasticity persist after the bony correction and undermine the result.
Modern practice has built on Steel's foundation by adding attention to the degree of correction, fragment vascularity, and concurrent labral pathology. Knowing this hierarchy. Salter, Pemberton, then Steel. Is essential for pelvic osteotomy questions on the OITE.