Fracture of the neck structures in suicidal hangings: a retrospective study on contributing variables

Abstract

Introduction: Several factors may play a role in the development of fractures of the neck structures in hanging. It has been repetitively demonstrated that the incidence of fractures increases with age. The role of other variables is less clear, different studies presenting contradictory results on the role of gender, the type of suspension, or the type of ligature. However, most of these studies evaluated these factors independently of the age of the victims. Considering that age is probably the most important factor in the development of neck structure fractures, all other contributing factors should be studied in relation to age. The aim of the present study is to evaluate the role of contributing factors to the development of neck structure fractures, taking age categories into account.

Materials and methods: A total of 206 cases were analysed for the presence and localization of thyroid fracture. For each case, the following information was also compiled: the presence and localization of other neck structure fractures, gender and age, height and weight, body mass index (BMI) type of suspension (complete or incomplete), type of ligature used (rope, wire, clothes, sheet or lace) and localization of the knot (anterior, right, left or posterior).

Results: The incidence of neck structure fractures increased with age (χ(2)=21.85; p<.001) and is significantly higher in male victims (31.4%) compared to female victims (11.8%) (χ(2)=5.41; p=.02). The incidence of fractures varied significantly with the height (t=2.19; p=.031; D=.33), weight (t=4.38; p<.001; D=.89) and BMI (t=3.84; p<.001; D=.60). The incidence of fractures did not vary significantly with the type of suspension (i.e. complete hanging with feet off the ground or incomplete hanging with body parts partially supporting the weight of the body) (χ(2)=3.12; p=.077; Phi=.077) and the type of ligature (i.e. narrow vs wide) (χ(2)=.05; p=.828; Phi=.015). However, when taking the age of the victims into account, a different picture was revealed: in individuals aged 40 years or more, victims with complete suspension of the body presented with a significantly higher incidence of fractures (63.2%) compared to victims with incomplete suspension (31.0%) (χ(2)=6.79; p=.009; Phi=.318).

Conclusion: Several variables contribute to the development of neck structure fractures in hanging. Age is probably the most important one. Other contributing factors are gender, height, weight, BMI and the type of suspension.