Neurogenic joint disease secondary to congenital insensitivity to pain

Congenital insensitivity to pain is a very rare disease, often familial in nature. It may be brought to the orthopaedic surgeon's attention by some peculiar manifestation of the locomotor system, such as: spontaneous fractures, or those brought about by minimal trauma; epiphyseal detachment; extensive bone necrosis; osteomyelitis; joint disease with no evidence of infection, but with the clinical and radiographic features of neurogenic arthropathy. The cases of two brothers who were followed up for more than 25 years are presented. The study is completed by a brief review of current hypotheses on the etiopathology of the syndrome.