School of Archaeology & Anthropology, Australian National University, Canberra, Australian Capital Territory, Australia.
Victorian Institute of Forensic Medicine/Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia.
J Forensic Sci. 2023 May;68(3):731-742. doi: 10.1111/1556-4029.15234. Epub 2023 Mar 20.
The frequency and distribution of fractures are commonly utilized to assist in interpreting the manner of death. In cases of alleged suicide by hanging, however, the evidence base for the frequency and patterning of laryngohyoid and cervical vertebrae fractures resulting from such blunt force traumatic events is limited and so fractures cannot be reliably used to assist in interpreting the manner. Using meta-analytic techniques, this study aimed to estimate frequency and distribution of fractures in the context of relevant intrinsic and extrinsic variables. A systematic review of the literature identified 20 studies with relevant data (8523 cases of suicide by hanging). Meta-analyses identified the frequency and distribution of fractures present and how fracture frequency was affected by the subgroups of age, sex, completeness of suspension, ligature knot position and study design. Results indicated that fracture frequency was variable, there was no unique patterning, and high levels of heterogeneity were present in all variable sub-groups. Age was the only subgroup to show differences. Findings suggest that neck fracture frequency is inconsistent and cannot be predicted by the chosen variables. Subsequently, neck fractures in isolation should not be given weight in medico-legal interpretations of a hanging death as suicidal.
骨折的频率和分布通常用于协助解读死亡方式。然而，在涉嫌上吊自杀的情况下，由于这种钝力创伤事件导致的喉舌骨和颈椎骨折的频率和模式的证据基础有限，因此骨折不能可靠地用于协助解读死亡方式。本研究采用荟萃分析技术，旨在估计相关内在和外在变量背景下骨折的频率和分布。系统文献回顾确定了 20 项具有相关数据的研究（8523 例上吊自杀）。荟萃分析确定了骨折的频率和分布，以及骨折频率如何受到年龄、性别、悬挂的完整性、系带结位置和研究设计等亚组的影响。结果表明，骨折频率是可变的，没有独特的模式，所有变量亚组都存在高度异质性。年龄是唯一显示出差异的亚组。研究结果表明，颈部骨折的频率不一致，所选变量无法预测。因此，孤立的颈部骨折不应在医学法解释上吊死亡为自杀时被重视。
