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Mix flour, sage, salt and pepper together.
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Form ground round into 4 oval steaks and dredge in seasoned flour.
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Reserve remaining flour for gravy.
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Cook steaks in oil until browned, 3 to 5 minutes on each side.
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Remove steaks from pan.
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Add onions to skillet and cook over medium heat until very brown.
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Spread remainder of seasoned flour over bottom of pan and stir until brown.
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Slowly add water, stirring until it begins to boil.
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Add milk, stirring constantly.
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Return steaks to gravy for about 5 minutes.
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Cover and turn off the heat and let stand for a few minutes to allow the meat to absorb the flavors.