A Study of Bony and Cartilaginous Neck Structures in Deaths Due to Suicidal Hanging at New Delhi

A meta‐analytic review of the frequency and patterning of laryngohyoid and cervical fractures in cases of suicide by hanging

“…As detailed in Figure 1, the search identified 120 studies of possible interest. Upon full‐text review of those papers, and in line with strict inclusion criteria detailed in Table S2, 20 studies [17–19, 27–31, 33, 34, 37–39, 41, 42, 50–54] were found to be suitable for a meta‐analytic investigation (see Figure 1). A diversity in the inclusion criteria was maintained to ensure breadth of analysis, the ability to effectively consider effect of sex and age on fracture frequency, and to see if the nature of these relationships was impervious to sample differences.…”

“…Heterogeneity in overall fracture frequency may also be explained by methodological differences and, whilst they were not quantifiable, they require consideration. First, it was recognized that, several studies did not provide details on the autopsy techniques or imaging methods utilized to identify neck fractures [28,33,34,38,39,41,[50][51][52][53][54]86]. A common method of determining presence of fracture is via visual and palpatory examination [7],…”

“…Third, there was variation in how neck fractures were defined and thus included or excluded from the study. Zátopková et al [17], Charoonnate et al [29] and Paparo and Siegel [41] only included fractures when they had associated macroscopic hemorrhage, whilst the remaining studies included all fracturing regardless of the presence of hemorrhaging [27,28,34,42], or did not specify [18,19,30,31,33,[37][38][39][50][51][52][53][54]. There is also no standardized classification system for fractures.…”