How often is a fractured hyoid bone found in suicidal hangings versus homicidal strangulation?

1. What the peer‑reviewed literature generally says: strangulation > hanging

Forensic authors repeatedly state that perimortem hyoid fracture is a recognized indicator of compressive neck force and is reported relatively commonly in manual (throttling) and ligature strangulation, while it is less frequently observed in hanging; this pattern appears across multiple reviews and studies ^{[6] [3] [5]}. Some reviews summarize that about half of “strangulation” cases show hyoid fracture (a frequently cited figure) whereas hanging series report lower proportions — but the precise percentages differ between papers ^{[4] [7]}.

2. Numbers you’ll see in the literature — and why they vary

Different sources quote different rates: a classic statement is that the hyoid fractures in roughly one‑third of homicides by strangulation ^[1]; other summaries give ~50% for manual or ligature strangulation and ~27% for hanging ^{[4] [7]}. A government review cited an estimate that hangings produce only 8% fractured hyoids ^[2]. Smaller series report values from about 10% up to 68% in particular hanging collections — showing how case selection, population age, and methodology shift percentages ^{[3] [8]}.

3. Major factors that change the likelihood of fracture

Age and ossification matter: older victims with fused or ossified hyoid synchondroses are far more likely to have fractures; Pollanen and colleagues found ossified hyoids in ~70% of fractured cases versus ~30% when unfractured, and older mean age among fractured cases ^[1]. Mechanism and locus of force matter: manual/throttling applies localized lateral/medial forces that fracture the hyoid more readily, while in hanging the force is the body weight through a ligature and may act differently depending on anterior vs lateral suspension and ligature position ^{[3] [5]}. Postmortem changes, detection methods (radiography, CT, autopsy technique), and whether cartilage fractures are included also alter reported rates ^{[9] [5]}.

4. How forensic practitioners interpret a fracture — not a one‑way proof

Authors caution that a hyoid fracture “frequently indicates” manual strangulation but is not pathognomonic: ligature strangulation, hanging, blunt neck trauma, even certain accidental mechanisms or age‑related fragility can produce similar findings, so context (scene, ligature position, other injuries) is essential to distinguish suicide from homicide ^{[6] [10]}. MedPage Today emphasizes that fracture location relative to the ligature and the overall autopsy/scene picture — not just presence of broken bones — guides the opinion ^[10].

5. Where disagreement or uncertainty remains

Reported rates in hanging diverge widely across series (from single digits up to reports claiming 68% in select samples), reflecting heterogeneous methods and possible publication or selection biases in small studies ^{[8] [3] [9]}. Systematic, population‑wide comparisons with standardized imaging and age stratification are limited in the provided material; therefore precise comparative frequencies remain imprecise in current reporting ^{[5] [11]}.

6. Practical takeaway for non‑specialists and investigators

Presence of a fractured hyoid increases suspicion for applied compressive neck force and is more suggestive of manual/ligature strangulation than of hanging in many series, but it is not definitive on its own; investigators and pathologists must weigh age‑related ossification, ligature position, other injuries, and radiologic/autopsy methods when assigning manner of death ^{[6] [1] [10]}.

Limitations: available sources show inconsistent percentages across studies and do not provide a single, universally accepted comparative frequency; variation is explained within sources by age, mechanism, and detection method ^{[1] [3] [2]}.