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Steel



- Discussion:
    - involves Salter osteotomy + osteotomy of both rami which results in placing articular cartilage over femoral head;
    - indicaitons:
         - older children w/ residual dysplasia & subluxation in whom there is minimal potential for remodeling;
         - older children w/ DDH since their symphysis pubis does not rotate as well;
- Technique:
    - ischium, superior pubic ramus, & ilium superior to acetabulum are all divided;
    - acetabulum is repositioned & is stabillized by a bone graft and metal pins;
    - ischial osteotomy:
        - is made far from joint;
        - performed through separate posterior approach w/ patient prone;
        - marked angular corrections create large deformity of ischium & potential for an ischial non-union