>>24993452

A break at the tip / distal (posterior) third of the greater horn happens in strangulation too. It is not hanging-only.What the location studies actually showPollanen’s detailed mapping (mostly manual strangulation, plus two hangings) put fractures here:

Posterior third of the greater horn (toward the tip): 47%

Middle third: 47%

Anterior third (near the body): 5%

So in strangulation, the tip/posterior horn is one of the two most common sites — not rare.

dl.astm.org

Experimental hanging-type loading puts a larger share in the distal third (~70%), which is why that site is more associated with hanging. Associated is not the same as exclusive.Why both mechanisms can break the same spotThe greater horn is a curved, relatively weak rod. It snaps at the sharpest bend (~30–60°, often ~50°) when force exceeds that point.Hanging: noose lifts the hyoid up and back; the tips jam into the cervical spine.

Manual: thumbs/fingers can still load the same curved distal horn, or drive the whole U-shape backward so the tips hit bone.

Ligature: a tight band can do either — squeeze the horns inward or shove the complex onto the spine — depending on how high and how hard it sits.

So “fractured at the tip” does not rule out strangulation. What would help more:Inward displacement + joint/synchondrosis break → more manual

Outward / tip-against-spine + no cricoid → more hanging-like

Same tip break can be either

Epstein’s public description (left greater-horn tip, “pressed against the spine”) fits hanging’s usual story.

The same site is still well documented in strangulation. Location alone cannot separate them.

What was foundEpstein, 66, had three antemortem neck-skeleton fractures:Left greater horn of the hyoid

Left superior horn of the thyroid cartilage

Right superior horn of the thyroid cartilage

Soft-tissue hemorrhage showed they happened while he was alive. The thyroid was almost fully ossified (normal at that age, more brittle). The cricoid was not fractured. Official ruling: hanging / suicide.Dr. Kristin Roman (autopsy doctor) said the sites fit hanging: hyoid broken at the tip, where it would press against the spine during suspension, and thyroid horns broken where the hyoid would have pressed on them — not the uneven, near-joint pattern she associated with hands squeezing the neck.Dr. Michael Baden (family’s pathologist, present at the autopsy) said three such fractures are extremely unusual in suicidal hanging and more consistent with homicidal strangulation.How common are these injuries?Rates vary by age, dissection quality, and study design. Age matters most: after ~40–50 the hyoid fuses and thyroid ossifies, so they break more easily.Any hyoid fractureHanging: classic 6–20%; careful/older series often 23–50%+

Ligature strangulation: 13–54%

Manual strangulation: 17–71% (some male series near 100%)

Combined hyoid + thyroid (both structures — closest to Epstein)Hanging: ~2–23%, typical working range ~7–16%

Examples: Godin 2.2%; English summary ~7.5%; 660-case series 12.1%; Nikolić ~16%; Zátopková 23%

Ligature: less published; DiMaio 8.3% both structures

Manual: generally higher; papers often report “hyoid and/or thyroid” rather than “both”

Same-study comparisons (fairest)Godin 2012 (231 hangings vs 52 homicidal strangulations):Any neck-skeleton fracture: 23.4% vs 65.4%

Combined hyoid + thyroid in hanging: 2.2%

Cricoid: 0% hanging vs 20.6% strangulation

DiMaio (48 ligature vs 41 manual):Ligature: hyoid and/or thyroid 12.5%; both 8.3%

Manual: hyoid/thyroid/cricoid fractures in 100% of men, ~52% of women

So: combined fractures are more common in strangulation, but they are not rare in hanging, especially in older adults with thorough exams.

Pollanen (mostly manual + 2 hangings): posterior 47%, middle 47%, anterior 5%. The break also follows that bone’s own curve (~50°), not only the mechanism.Can a tip fracture happen in strangulation? Yes. The distal/posterior greater horn is one of the two most common sites in strangulation series. A tip break does not prove hanging. Roman’s extra claim — tip because it hit the spine — is the hanging-specific story; the same spot can still snap from a grip or ligature.Which way the fragment movesTextbook rule (not absolute):Inward (horns squeezed toward midline): classic manual

Outward / anteroposterior (horns levered back onto the spine): classic hanging and many ligature cases

Real cases overlap. Hanging can be inward; strangulation can be mixed. Public Epstein material describes “left greater horn / tip vs spine,” not a clear published inward-vs-outward measurement.How Epstein fitsFeature

Epstein

Leans toward

3 fractures, hyoid + both thyroid horns

Yes

Strangulation more often, but hanging does this in a minority

Hyoid at tip, explained as against spine

Official description

Hanging

Thyroid both superior horns

Yes

Both mechanisms

Cricoid intact

Yes

Hanging (a cricoid break would favor homicide)

Inward vs outward

Not clearly published

Would help more than the count

Bottom line from the whole threadThe fractures are real and occurred in life.

Multiple / combined hyoid + thyroid breaks are more frequent in strangulation than hanging. That is the strongest statistical point on Baden’s side.

Combined breaks still occur in a meaningful share of hangings, especially at age 66. They are not “never seen.”

A distal-tip hyoid fracture can occur in hanging and both kinds of strangulation.

The official hanging argument is about pattern: tip against spine + matching thyroid sites + no cricoid.

The homicide argument is about count and rarity: three fractures more typical of a squeeze.

Bones alone do not settle it. Displacement direction, exact joint-vs-tip measurement, ligature-mark geometry, defensive injuries, and the cell/scene evidence sit outside what the fracture percentages can prove.

No single percentage or break site is diagnostic. The data support a real difference in frequency, and a real overlap in location.