Fracture of the Cricoid as a Potential Pointer to Homicide

Abstract

The distinction of a suicidal hanging from a simulated hanging following a homicidal strangulation is highly challenging. The present study evaluates the fracture of the cricoid cartilage as a potential pointer toward homicide. Despite the numerous studies on neck structures fractures in hanging, this is the first study to concentrate on the cricoid cartilage. Neck structures fractures in all cases of suicidal hanging over a 6-year period were retrospectively reviewed (231 cases) and a comparison with homicidal hangings (4 cases) and homicidal no-hanging strangulations cases (52 cases) was performed. Overall, neck structures fractures were found in 23.4% of suicidal cases (54 cases). The cricoid cartilage was intact in all suicidal hangings. The general incidence of fractures in homicidal no-hanging strangulation was 65.4% (34 cases),with an incidence of fracture of the cricoid cartilage of 20.6%. By compiling studies from the literature, only one cricoid cartilage over 2700 suidical hanging cases was found, whereas an incidence of 5 to 20% is found for homicidal strangulation. It is therefore proposed that the presence of a fracture of the cricoid in an apparent suicidal hanging should be considered highly suspicious.

Fracture of the neck structures in suicidal hangings: A Retrospective study on contributing variables

“…In the literature, the incidence varies widely from one study to the next, from 0 to 76.8% [4][5][6]. This variation is not surprising considering that the expected incidence will vary significantly depending on the proportion of older people in the series.…”

“…The incidence of such fractures varies from one study to the next, from 0 to 76.8% [4,5]. In a recent paper, a meta-analysis of all English studies revealed an incidence of neck structure fractures of 36.6% AE 24.7 [6]. The majority of these fractures are isolated thyroid cartilage fracture (15.3% AE 12.1), followed by isolated hyoid bone fracture (11.5% AE 12.1) and combined thyroid cartilage and hyoid bone fracture (7.5% AE 6.1).…”

Pathological Findings in Hanging: Is the Traditional Knowledge Correct?

“…Another study, published in 2009, examined the significance of Simon's haemorrhage in a case series consisting only of hangings, where a total of 178 hanging cases were observed and analysed to evaluate how many presented Simon's sign and how many did not [27]. In 2009, a group of Canadian authors investigated the diagnostic value of cricoid cartilage lesions in relation to hanging, particularly in terms of differential diagnosis with homicide [28]. In 2018, a study by Swiss authors analysed the intervertebral vacuum phenomenon (VP).…”

Anthropological analysis of trauma in throat bone and cartilage: A review

“…Godin et al. [ 77 ] reported that fracture of the cricoid is rare in suicidal hangings but common in homicidal strangulation. In cases of possible simulated hanging following homicidal strangulation [ 78 ], cricoid fracture may be a significant finding.…”