When performance declines: culturally mediated delay in pediatric knee fracture following traditional healing and scarification-a case report from rural Cameroon.

Background: Delayed presentation of pediatric musculoskeletal trauma remains a critical yet underexplored challenge in sub-Saharan Africa, where cultural beliefs, socioeconomic constraints, and reliance on traditional healing practices frequently postpone biomedical consultation. The functional and neurobehavioral consequences of such delays in the pediatric population have received limited scientific attention. Case presentation: We report the case of a 17-year-old male adolescent from Foumbot, a rural community in the West Region of Cameroon, who sustained a left knee injury during a neighborhood football match. Due to financial hardship and culturally rooted health beliefs, the family initially sought traditional care, including repeated massage sessions and therapeutic scarification around the knee. No biomedical consultation was pursued for three months. The patient was eventually referred to the Physical Medicine and Rehabilitation Unit of the Regional Hospital of Bafoussam after his football coach identified a progressive decline in athletic performance and encouraged medical evaluation. Clinical examination revealed limited knee range of motion (active flexion 75°, extension deficit 15°), pain on weight-bearing (Visual Analog Scale 7/10), visible scarification scars, muscular deconditioning, and kinesiophobia. Radiographic evaluation revealed significant regional demineralization of the distal femur and proximal tibia consistent with disuse osteopenia, along with cortical irregularities suggestive of a neglected traumatic injury with delayed consolidation. Baseline functional assessment using the Lysholm Knee Score (41/100, "poor") and Tegner Activity Scale (level 2) documented significant functional impairment. Intervention: A seven-week progressive rehabilitation program was implemented, structured in three phases: (1) therapeutic education and cultural alignment with family co-therapy training; (2) progressive mobilization with task-oriented motor training and proprioceptive exercises; (3) sport-specific reintegration with confidence restoration strategies. Parents were actively involved as co-therapists following the previously validated Cogni-Famille model. Outcomes: At seven weeks, the Lysholm Knee Score improved from 41 to 87/100 ("good"), the Tegner Activity Scale from level 2 to level 7, pain decreased from 7/10 to 1/10, active flexion reached 130°, and extension deficit resolved. The patient returned to competitive football without significant limitation. Conclusion: This case illustrates how culturally mediated therapeutic delay, driven by the convergence of benevolent parental neglect, traditional healing reliance, and socioeconomic barriers, can lead to significant functional impairment in pediatric trauma. The observation that consultation was triggered by performance decline detected by a community actor rather than by pain or parental initiative underscores the potential role of sports coaches, teachers, and community leaders in early detection and referral. Culturally sensitive rehabilitation strategies, family-centered care, and community-based screening represent promising approaches to improve pediatric trauma outcomes in low-resource settings.