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What percentage of suicidal hangings show a fractured hyoid bone in forensic studies?
Executive summary
Forensic studies report a wide range for the frequency of hyoid‑bone fractures in suicidal hangings — individual series report figures as low as about 10–16% and as high as ~71%, while several larger or review studies report intermediate rates (e.g., ~15–28% for isolated hyoid fractures and overall laryngohyoid fracture rates up to ~72%) [1] [2] [3] [4] [5]. Variability reflects differences in methods (radiology vs gross dissection vs stereomicroscopy), which neck structures are counted (hyoid alone vs thyroid cartilage vs combined laryngohyoid fractures), age of decedents, and type/position of hanging [6] [1] [2] [3] [5].
1. The published numbers: a fractured hyoid is common — but how common?
Single‑center autopsy and imaging studies report a range: a 40‑case prospective autopsy series found hyoid fractures alone in 10% and both hyoid+thyroid cartilage in 15% (total neck‑structure fractures 47.5%) [1]; a 100‑case morphometric study reported detectable hyoid fracture in 16% [2]; a Thai series of 20 suicidal hangings reported fractures of hyoid and/or thyroid cartilage in 25% (hyoid fractures specifically in fewer cases) [6]. Conversely, some protocols that use systematic radiographs, meticulous soft‑tissue removal, or combined imaging and dissection report much higher overall laryngohyoid fracture rates — for example a recent protocol study found fractures in 71.4% of cases when thyroid and cricoid were included [4]. Meta‑analytic and review work also emphasizes a broad spread of reported incidences [5] [7]. These differing numerators and denominators (hyoid alone vs any laryngohyoid fracture) explain much of the spread [5] [1].
2. Why reported rates vary so widely: methods, definitions, and population
Authors explicitly link variability to examination technique (visual palpation vs stereomicroscopy vs radiology/CT), which can reveal subtle fractures missed on gross exam [6] [4]. Studies that count only isolated hyoid fractures naturally give lower percentages than those that count any laryngohyoid injury (thyroid cartilage + hyoid + cricoid) — e.g., isolated hyoid fractures reported 10–16% in some series, while combined laryngohyoid fracture rates can be 47–72% [1] [2] [3] [5]. Age matters: older decedents with ossified hyoids show higher fracture rates, and lateral (off‑center) suspension produces more laryngohyoid fractures than anterior hangings [6] [1] [3].
3. How experts and reviews frame the significance of a broken hyoid
Forensic literature repeatedly warns that a hyoid fracture by itself is not a definitive marker of homicide versus suicide; the finding must be interpreted with scene evidence, ligature position, and other autopsy findings [8] [9]. Reviews note that in homicidal strangulation hyoid fracture is also common (for example around one‑third in some strangulation series), so frequency differences are probabilistic rather than absolute [9] [8]. Journalistic commentary about high‑profile cases has pointed to studies showing 25% or similar rates in suicidal hanging to argue a fractured hyoid is not rare in suicides [10].
4. Best way to answer “what percentage?” for practical use
If the question is specifically “what percent of suicidal hangings show a fractured hyoid bone,” available studies cluster roughly into two groups: those reporting isolated hyoid fractures in ~10–16% of cases [1] [2], and those reporting higher rates when including thyroid/cricoid or using exhaustive protocols (up to ~71% in one recent prospective protocol study for any laryngohyoid fracture) [4] [3] [5]. Meta‑analytic reviews stress that reported incidence ranges widely (0–100% across older literature) and that a pooled or single “true” percentage is elusive because of heterogeneity [5] [7].
5. Limitations, disagreements and what reporters should avoid
Available sources disagree on precise percentages and explicitly caution against overinterpreting a single fracture as proof of homicide or suicide — methodological differences, case selection, and whether the thyroid cartilage is included produce conflicting numbers [5] [6] [1]. Claims that a broken hyoid “proves” strangulation are refuted in the literature because fractures occur in both contexts and increase with age and mechanism [9] [8]. Where a specific single percentage is cited in public debate, check whether that study counted isolated hyoid fractures, combined laryngohyoid fractures, used imaging, or included older decedents [1] [4] [2].
6. Bottom line for readers and investigators
There is no single consensus percentage; expect isolated hyoid‑only fractures in roughly 10–25% of suicidal hanging series but much higher overall laryngohyoid fracture rates (up to ~70% in some meticulously examined cohorts) when thyroid and other neck cartilages are included and sensitive methods are used [1] [2] [4] [5]. Interpreting a fracture requires context: age, ligature position, dissection/radiology method, and other autopsy/scene findings [6] [8] [9].