most individual comparative studies and classic reviews report higher rates of hyoid and thyroid cartilage fractures in ligature strangulation than in hanging. The difference is real in the literature, but it is smaller and more qualified than older textbooks sometimes claim. ojp.gov
Typical numbers from studies that compare both
Ubelaker’s 1992 literature compilation (still widely cited) is representative of the older aggregated picture:
• Hanging: hyoid ~8%, thyroid ~15%, cricoid essentially 0%
• Ligature strangulation: hyoid ~11%, thyroid ~32%, cricoid ~9%
• Manual strangulation: hyoid ~34%, thyroid ~34% ojp.gov
Individual mixed-series papers usually show the same direction, even if the exact percentages jump around:
• Hyoid fracture: hanging 2.8–9% vs ligature strangulation 24–25% (small ligature samples). researchgate.net
• Any neck-structure fracture: hanging ~23% vs homicidal strangulation (ligature + manual) ~65%. journals.lww.com
• Many Indian autopsy series (young hanging victims) report hanging hyoid fractures of 0–5% and call fractures “common” in the few ligature cases they have. researchgate.net
Godin’s series is typical of the “any fracture” comparison: 23.4% of suicidal hangings vs 65.4% of homicidal non-hanging strangulations. journals.lww.com
Why the difference appears
• Ligature strangulation is usually horizontal, complete, and lower on the neck (often directly over the larynx). Force is applied more directly and often for longer because of struggle.
• Typical suicidal hanging is higher, oblique, and more sliding/tangential. Many series are also dominated by young adults whose hyoid and thyroid horns are still flexible and unossified.
Age/ossification is the single strongest predictor in both mechanisms. Fractures become much more common after ~40 years regardless of hanging vs ligature. onlinelibrary.wiley.com
Important caveats (so the picture is not overstated)
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Hanging rates vary enormously (0% to >70%) depending on how the neck is examined and how old the victims are. Routine autopsy series often miss fractures; complete dissection + radiology in older European/North American hanging victims finds laryngohyoid fractures in 45–72% of cases, with thyroid horns more often broken than the hyoid. sciencedirect.com
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Ligature-strangulation series are almost always tiny (often n = 4–20), so their percentages are unstable.
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Thyroid superior-horn fractures occur readily in both; they are not very discriminatory.
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Cricoid fracture is a better pointer than hyoid or thyroid. It is rare in hanging (classically cited as ~1 in 2700 in older compilations) and occurs in roughly 5–20% of homicidal strangulations. Even this is not absolute — a few recent meticulous hanging studies have found occasional cricoid fractures. journals.lww.com
Bottom line: If you look only at individual studies that put hanging and ligature strangulation side-by-side, most of them do show higher percentages of both hyoid and thyroid fractures in ligature strangulation. The difference is clearest for overall neck-structure injury and for cricoid fractures; it is more modest and age-dependent for isolated hyoid or isolated thyroid-horn fractures. Absence of fractures never excludes either mechanism.