Removal of fragments
After the capsulotomy, the joint is irrigated and large fragments are picked out using forceps, pituitary rongeurs etc.
All fragments identified on the preoperative MRI should be accounted for.
Subluxation by traction, with internal and external rotation, is useful for visualization of the joint and to free trapped fragments.
Irrigation of the subluxed joint will often flush out hidden fragments.
For larger fragments, complete hip dislocation may be necessary.
Image intensification should be used to confirm concentric reduction.