Adult presentation of neglected congenital muscular torticollis is rare. We report 12 patients with this condition who underwent a modified Ferkel's release comprising a bipolar release of sternocleidomastoid with Z-lengthening. They had a mean age of 24 years (17 to 31) and were followed up for a minimum of two years. Post-operatively a cervical collar was applied for three weeks with intermittent supervised active assisted exercises for six weeks. Outcome was assessed using a modified Lee score and a Cheng and Tang score. The mean pre-operative rotational deficit was 8.25° (0° to 15°) and mean lateral flexion deficit was 20.42° (15° to 30°), which improved after treatment to a mean of 1.67° (0° to 5°) and 7.0° (4° to 14°) after treatment, respectively. According to the modified Lee scoring system, six patients had excellent results, two had good results and four had fair results, and using the Cheng and Tang score, eight patients had excellent results and four had good results. Surgical management of adult patients with neglected congenital muscular torticollis using a modified Ferkel's bipolar release gives excellent results. The range of neck movement and head tilt improved in all 12 patients and cosmesis improved in 11, despite the long-standing nature of the deformity.

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➢ Nonunion is the third most common complication of femoral neck fractures in children after osteonecrosis and premature physeal closure causing coxa vara.➢ The most common cause of nonunion of a femoral neck fracture in developed countries is failure of fixation or loss of reduction, whereas in developing countries, it is delayed presentation.➢ Most failures of fixation, if identified in time (<3 months), retain adequate bone contact. Hence, removal of the offending implant, refixation without bone-grafting, and valgus osteotomy to correct the biomechanical forces by converting the vertical fracture line into a horizontal fracture line provide adequate results with respect to osseous union.➢ In patients with a delayed presentation, the intervening fibrous tissue and resorption of the neck pose challenges. In these patients, in addition to performing a valgus osteotomy and fixation, in situ stabilization across the fibrous tissue and reconstruction of the inferomedial aspect of the neck using fibular strut-grafting, which adds stability, bone contact, and biological material, provide adequate union.

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