Multiple fractures of the hyoid and thyroid cartilage are more common in strangulation (especially manual) than in hanging, but they are not rare in hanging either—particularly in older adults.Hyoid fracture rates (the most compared number)Classic review figures (Ubelaker and later summaries):Hanging: roughly 6–20% (some older or less thorough studies much lower; careful dissection studies higher)

Ligature strangulation: 13–54%

Manual strangulation (throttling): 17–71%

One small series found hyoid fractures in 100% of 4 manual-strangulation cases versus ~21% of hanging cases. An Indian series reported 2.8% in hanging, 25% in ligature strangulation, and 50% in throttling.

aafs.org

So a broken hyoid is more frequent in homicide strangulation than in hanging, but it still happens in a meaningful minority of hangings.Combined / multiple fracturesThis is closer to Epstein’s pattern (1 hyoid horn + both thyroid superior horns).In hanging series with careful exam:Combined hyoid and thyroid fractures: commonly 16–23% of all hanging cases in larger prospective or well-dissected studies (Nikolić 16.2% of 557; Zátopková 23% of 178).

Isolated thyroid is usually the single most common finding in hanging.

One German series of 109 hangings found:1 fracture: 38% of those who had any fracture

2 fractures: 37%

3 fractures: 15%

all four horns broken: 10%

So three fractures occurred in about 10% of all hanging cases in that series. Other thorough studies report 0–6 fractures per hanging case.

ovid.com

In strangulation, injuries are generally described as more extensive: more fractures, more hemorrhage, and a higher chance of involving both structures plus the cricoid. Cricoid fractures are rare-to-absent in hanging and seen in 5–20% of homicide strangulations, which is why some authors treat a cricoid fracture as more suggestive of homicide. Epstein had no cricoid fracture.

pmc.ncbi.nlm.nih.gov

Bottom line on “multiple”Any hyoid or thyroid fracture: more common in strangulation than hanging.

Multiple (2+) or combined hyoid + thyroid: still more common in strangulation, and the injuries tend to be more numerous and accompanied by more soft-tissue hemorrhage.

Three fractures of the exact type Epstein had do occur in documented suicidal hangings, especially in people in their 60s whose hyoid and thyroid are ossified and brittle. They are not “never seen” in hanging.

The frequency difference exists and is real, which is why Baden highlighted it. It is not large enough or specific enough by itself to distinguish hanging from strangulation. Location of the breaks, presence/absence of cricoid injury, hemorrhage pattern, ligature mark geometry, and scene findings matter more than the raw count of fractures.

>>24993452

Best individual hanging numbersThese are the cleaner published figures for combined hyoid + thyroid in hanging:2.2% — Godin et al., 231 suicidal hangings (younger sample, mean age 34.5)

7.5% ± 6.1 — summary of English-language studies

12.1% — 660 hanging autopsies (2026 prospective series): 80 combined cases

12.5% — one 56-case hanging series

15% — Green et al., 40 hangings

16.2% — Nikolić et al., 557 hangings (27% of the injured cases had both)

23.0% — Zátopková et al., 178 hangings (thorough prospective dissection)

mdpi.com

So a realistic working range for hanging is about 7–16%, with thorough older-adult series reaching the low 20s.Strangulation (the comparison you asked for)Direct head-to-head series are smaller because homicidal strangulation is much less common than hanging.Godin compared 231 suicidal hangings vs 52 homicidal strangulations:Any neck-structure fracture: 23.4% hanging vs 65.4% strangulation

Combined hyoid + thyroid in the hanging arm of that study: 2.2%

One 31-case strangulation series (18 ligature + 13 manual): hyoid and/or thyroid fractured in 74% overall.Ligature: hyoid 28%, thyroid 50%

Manual: hyoid 31%, thyroid 62%

Another ligature-strangulation series cited in the literature: thyroid 35%, hyoid 15%, both 5%.

Among the few strangulation cases that did have fractures, both structures were often involved (e.g., 4 of 6 fractured victims in one small group had both hyoid and thyroid).

journals.sagepub.com

Simple takeawayCombined hyoid + thyroid: roughly 2–23% in hanging vs clearly higher in strangulation, especially manual.

Any fracture at all: hanging often 23–50% (higher when dissection is thorough and victims are older); strangulation commonly 60–75%.

Manual strangulation produces the highest rates and the most extensive damage; ligature strangulation sits in between hanging and manual.

The gap is real: combined fractures are more common in strangulation than hanging. They are not rare enough in hanging (especially at age 66) to be considered diagnostic on their own.

>>24993452

>>24993452

Baker, make this notable so the FBI knows we know