The location of hyoid fractures in strangulation revealed by xeroradiography

The location of 19 fractures of 15 hyoid bones was studied from 13 cases of manual strangulation and two cases of hanging. The precise location of the fractures were determined by xeroradiography of isolated hyoid bones. To classify the location of the fractures, the greater cornu was divided into anterior, middle, and posterior thirds and the frequency of fracture occurrence in these locations was determined. In addition, the angle of curvature of the greater cornu was determined at the fracture site to ascertain if specific points along the greater cornu were more susceptible to fracture. Fractures were found with equal frequency in the posterior and middle thirds of the hyoid greater cornu (9/19, 47% for both posterior and middle) but were rare in the anterior portion (1/19, 5%). However, all fractures occurred between 30 degrees and 60 degrees of curvature of the hyoid and most fractures (approximately 60%) were found at approximately 50 degrees. These results indicate that fractures of the hyoid occur at vulnerable angles of curvature of the hyoid bone which, due to anatomic variation in hyoid shape, do not necessarily occur at specific segments of the hyoid bone. On this basis, although the presence of the hyoid fracture in strangulation is determined by the rigidity of the bone, the specific location is determined by the shape of the greater cornu.