Traction After Manual Hip Dislocation Reduction
No, traction should NOT be used after manual reduction of traumatic hip dislocation—early mobilization is the preferred approach based on current evidence.
Immediate Post-Reduction Management
Early mobilization within days of reduction is safe and superior to prolonged traction. A comparative study of 41 patients with traumatic hip dislocation without fracture demonstrated that patients mobilized an average of 9 days after reduction had comparable long-term outcomes to those placed in skeletal traction for 2 weeks, with no cases of avascular necrosis in either group 1. Critically, the early mobilization group experienced no early complications and achieved earlier return to work, making this the more practical and patient-centered approach 1.
Evidence Against Routine Traction Use
The strongest guideline evidence specifically addresses hip fractures rather than dislocations, but the principle is clear: preoperative traction should not be used for hip fracture patients according to the American Academy of Orthopaedic Surgeons 2, 3. While this addresses a different clinical scenario, the underlying rationale—lack of demonstrated benefit and potential for increased morbidity—applies similarly to post-reduction management of dislocations.
For traumatic hip dislocations specifically:
- No avascular necrosis occurred in patients managed with early mobilization versus traditional traction protocols 1
- Post-traumatic arthritis rates were actually lower in the early mobilization group (1 case) compared to the traction group (3 cases) 1
- Heterotopic ossification rates were equivalent between approaches (2 cases each) 1
Recommended Post-Reduction Protocol
Implement the following management strategy:
- Mobilize patients within the first week after successful closed reduction, typically around 9 days post-reduction 1
- Allow partial weight-bearing initially, progressing to full weight-bearing by 3 months 1
- Avoid skeletal traction unless specific contraindications to early mobilization exist 1
Important Clinical Caveats
The context matters significantly. The evidence supporting early mobilization applies specifically to:
- Traumatic hip dislocations without associated acetabular or femoral fractures 1
- Successful closed reduction performed promptly (average 2 hours after injury in the key study) 1
If fractures are present, management changes entirely and surgical fixation principles apply, where the American Academy of Orthopaedic Surgeons explicitly recommends against preoperative traction 2, 3.
Special Circumstances Where Traction May Be Considered
Heavy traction has limited application only in neglected/chronic dislocations. For old posterior dislocations (not acute reductions), heavy traction of 7-18 kg applied for 5-17 days under sedation achieved successful reduction in 6 of 7 patients with good outcomes 4. However, this represents a completely different clinical scenario than acute post-reduction management and should not influence routine practice 4.
Traction tables may facilitate the reduction maneuver itself to decrease physical burden on surgeons during the reduction procedure 5, but this is distinct from post-reduction traction therapy.