Frequency of Throat-Skeleton Fractures in Hanging :

By examining 80 consecutive cases of death due to hanging, fractures of the thyroid cartilage or the hyoid bone or both, were noted in 45%. Fracture of the cricoid cartilage did not occur. No fracture occurred below the age of 25, and the frequency was slightly increasing with increasing age. There was a preponderance of fractures in males. The highest incidence of fractures was noted in typical hangings, while incomplete hanging to a very great extent was combined with congestion to the face, especially if the location of the ligature was atypical. Typical hanging in general did not produce congestion. The lividity in the declivous areas became fixed at the earliest after 5-6 h suspension time, while after 12 h almost all the cases demonstrated fixed lividity in the distal parts, especially in the legs. There is slight indication that the frequency of fractures increases with the length of suspension time.

Over a 10-year period in which both a retrospective and prospective study of suicidal hangings was made, fractures of the thyroid cartilage alone, or the hyoid bone alone, or of both together were noted in 20% of the cases. In the prospective study, an incidence of 46% was found. This contrasts sharply with the incidence of 15% in the retrospective study. This wide discrepancy indicates the need for longer periods of a controlled prospective study by properly trained prosectors. Fractures were found in all age groups above 19 years of age and occurred whether suspension was complete or incomplete, whether the ligature was soft or hard, narrow or wide, and whether decedents did or did not jump from a platform. The higher incidence of fractures occurring among women is unexplained. The presence of reddish or pink bands or linear streaks (with or without superimposed abrasions) along one side of the neck, separated by bands of pale skin, canting upwards towards the back of the neck and revealing the imprint of a folded cloth permits the diagnosis of ante-mortem hanging in the absence of very strong proof to the contrary. As in any type of Medical Examiner's case, a knowledge of the circumstances and investigation of the scene are required before a final determination of the cause and manner of death can be considered.