Which fracture of the neck structure is considered MOST pathognomonic of homicidal throttling (manual strangulation)?

• A Fracture of the hyoid bone (greater cornu) ✓
• B Fracture of the posterior arch of C1 vertebra
• C Fracture of the superior cornu of the thyroid cartilage
• D Fracture of the cricoid cartilage ring

Explanation

Fracture of the hyoid bone, particularly the greater cornu, is considered the most characteristic skeletal injury in throttling/manual strangulation. The hyoid is protected by the mandible in younger persons, but as it ossifies and becomes more brittle with age (typically after 40 years), digital pressure during throttling easily fractures the greater horns. Thyroid cartilage fractures also occur in strangulation but are less specifically associated with manual throttling alone. Hyoid fracture is rarely seen in hanging (more common in judicial hanging) and is virtually absent in smothering.

Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.

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Written and medically reviewed by the StethoPrep medical team.