Hyoid Bone Fracture in Neck Strangulation: Five Years Meta-Analysis at Tertiary Care Hospital

Abstract

Objectives: To find out the hyoid bone fractures in various modalities of compression to the neck i.e. Neck strangulation, Hanging, Garroting and Throttling and to study the socio-demographic characteristics of those victims brought for autopsy. Study Design: Cross Sectional Study (Descriptive) Setting and Duration: This study was conducted in Autopsy Section of DHQ Hospital Dera Ghazi Khan, Punjab, Pakistan for a period of five years from January, 2013 to December, 2017. Methodology: Total 87 medico legal autopsies were labeled as the cases of neck compression & police papers depicted history of strangulation at the level of neck. After careful observation of all related findings of ligature strangulation, throttling and hanging; the hyoid bone was examined in each case. Results: Mean age of the victims was 24.16±15.23. Out of 87 cases, 53(60.9%) were male and 34(39.1%) female. According to the police inquest, 52(59.8%) victims belonged to lower socio- economic status while urban area predominance appreciated in 61(70.1%) cases. Modalities of the neck strangulation included 62(71.26%) cases of hanging, 9(10.34%) cases of garroting and 16(18.40%) cases of throttling. Hyoid bone was found fractured in 18(20.7%) cases and out of those, throttling was the most common cause of hyoid bone fracture in 12(75.0%) victims of neck compression. Occupational data revealed 13(72.2%) victims belonged to lower socio-economic status, 3(16.6%) from average socio-economic background while 2(11.1%) belonged to the better economic group. As regards residential status; 10(55.6%) victims were inhabitants of rural areas while 8(44.4%) belonged to the urban setup. Conclusion: Fracture of the hyoid bone is rare and attention should be paid towards cases of throttling instead of hanging to find out these lesions during autopsy.  Examining doctors overemphasize the importance of hyoid bone & ignore the soft tissue injuries of neck due to faulty dissection techniques. Being a task of immense importance, the autopsy techniques should be improved by arranging practical training under supervision of the experts of Forensic Medicine Department at the regional Medical Colleges.