Ligature Material Research Articles

Study of Incidence of Hyoid Bone Fractures in Cases of Death due to Hanging, Strangulation and Throttling

Violent asphyxial deaths are among the most confounding of all entities that commonly confront a Forensic expert. A major portion of all unnatural deaths resulting from asphyxia are due to fatal neck compression. In the present study a total of 113 cases comprising of 107 cases of hanging, 4 cases of strangulation and 2 cases of throttling brought to the mortuary of the GGH, Gulbarga between the years September 2007 and August 2012 was taken up, to compare the incidence of hyoid bone fractures with reference to the age and sex of the victim, ligature material used, the type and the site of fracture.

Homicide Disguised By Suicide: A Rare Case Report

Violent asphyxial deaths are of common occurrence and constitute large group in medico-legal autopsies. Death due to constriction of neck may broadly result due to hanging, strangulation with ligature material or manual strangulation i.e. throttling. Sometimes due to external post-mortem appearance of the ligature marks on neck, it becomes difficult for the autopsy surgeon to clearly state whether the constriction of neck is homicidal or suicidal in nature. So in these cases, the expertise & high index of suspicion by “an expert forensic surgeon” is warranted to unmask the murder in disguise. Here we are presenting a case of man who supposed to hanged himself with the help of a nylon rope as per statement given by his wife and fabricating a scene of incidence as hanging and also the preliminary investigation by police as narrated before autopsy both were same. But a meticulous autopsy revealed that, cause of death is throttling and ultimately police registered a criminal case of murder against the alleged accused i.e. on his wife.

Pattern of external and internal findings in deaths owing to hanging—a study in northeast Delhi

Background: Hanging is a common form of asphyxial deaths. A complete profile of findings is helpful in making exact diagnosis of hanging and differentiating it from strangulation. Objective: To assess the complete profile of findings in deaths owing to hanging. Materials and Methods: A total of 101 cases of hanging were examined during autopsy. The details about the victims with regard to the age, sex, and type of ligature material and autopsy findings were noted. The data thus obtained were analyzed for the study. Result: A total of 101 cases of hanging were studied during November 2009 to February 2011, of which 43.56% of cases were in the age group of 21–30 years, and 68.31% were male subjects, single mark was seen in 95.04% cases, incomplete ligature was found in 99% cases, chunni was the commonest (37.70%) ligature material used, the knot was on the right side of neck in 45.60% of cases, and fixed knot was found in 68.85% of cases. Fracture of hyoid bone was found in 5.94% of cases, and that of thyroid cartilage was found in 4.95% of cases; salivary stains were found in 66.33% of cases; petechial hemorrhages were found in 11.88% of cases on external body surface and in 87.12% cases in internal body organs. Congestion of internal body organs were found in 96.03% of cases. Conclusion: In our study, findings in the cases of hanging varied and were found in many combinations. A correct interpretation of such findings and meticulous postmortem examination is necessary to make a confirmatory diagnosis of death owing to hanging.

Course of Near-hanging Victims Succumbed to Death: A Seven Year Study

Near hanging refers to victims who survive a hanging injury following attempted hanging, long enough to reach hospital. Delayed deaths in near hanging patients are mostly due to complication of hanging. The purpose of this study was to evaluate the demographics, mortality patterns and cause of delayed deaths in near hanging victims. In this study autopsy files over a seven year period from 2007 to 2013 were reviewed, and data of near hanging deaths (attempted hanging cases who succumbed to death and subjected for medicolegal autopsy) was extracted. Records of 14,000 autopsies was reviewed, and 10 deceased having died delayed deaths after near hanging episode were identified. In each case, the patients' details, including gender, age, type of suspension, type of ligature material used for hanging and subsequent hanging mark produced were reviewed using autopsy reports and photographs taken during autopsy. Demographic and pathological aspects of the each case discussed to throw light on autopsy findings in victims who died following near hanging. Complete suspension was present in 3 cases, while partial suspension was present in 7 cases. Survivals in delayed death after near hanging episode have ranged from 9 h to 72 d. Hypoxic encephalopathy was the most common cause of death, followed by pneumonia. Most of the near hanging patients did succumb to hypoxic encephalopathy; however, consolidation of lungs (pneumonia) was the next common cause of death reflecting need for aggressive oxygen therapy and selective resuscitation should be performed in all such cases.

Suicide by hanging : a study of 334 cases

Global suicide rates have increased 60% in the past 45 years. Its incidence is also high in Bangladesh and the mode of suicide is hanging in majority of cases. This study summarizes the post mortem examinations on 334 cases of suicide by hanging during 2010 to 2012 in the Department of Forensic Medicine, Sir Salimullah Medical College and Mitford Hospital, Dhaka. The focus was on its epidemiology in Bangladesh and to identify factors that contributed to suicide. Among the 334 cases, 69.2% were male and 56.0% were married. Most (62.3%) were between 20 to 40 years. Most of the victims were from middle socioeconomic group. Regarding motive for committing the suicide by hanging, family disputes were most common motive (38.9%) in male and in female the most common motive was harassment particularly in married women (23.1%). The high incidence of suicidal hanging among young adults imposes a huge socioeconomic burden on our society. Private nature of hanging and easy availability of ligature materials and ligature points makes prevention of suicide by hanging a difficult task. Social, legal and psychiatric interventions are required to prevent suicide. DOI: http://dx.doi.org/10.3329/bmj.v43i2.21390 Bangladesh Med J. 2014 May; 43 (2): 90-93

Deaths due to hanging among adolescents – A 10-year retrospective study

The present study was carried out to analyze various factors associated with death due to hanging among adolescents and to identify the areas of intervention for preventing such deaths. A retrospective study was carried out on 51 cases of adolescent deaths due to hanging, the autopsies of which were conducted by the Department of Forensic Medicine, Dr Shankarrao Chavan Government Medical College, Nanded, Maharashtra State (India), during the period between 1 January 2001 and 31 December 2010.In the present study, death by hanging among the adolescent age group was most commonly suicidal (96.08%) in nature, and only two (3.92%) cases of deaths due to accidental hanging were observed. Of the total number of suicidal deaths due to hanging among adolescents, the majority (80.39%) were among the older adolescent (15–19 years) age group. Rope and clothing items were commonly used ligature materials for committing suicide by hanging. Females outnumbered male victims (M:F ratio 1:1.13) among adolescents, contrary to the male preponderance observed among victims of the older age group (M:F ratio 1:0.44). Most of the suicidal deaths due to hanging (83.67%) among adolescents were observed at the victims' home. The predisposing and precipitating factors observed were domestic strife, examination-related stress, and physical and psychological illness.

Ligature material in hanging deaths: The neglected area in forensic examination

The hanging mark is the most relevant feature of hanging and its characteristics are well known in the literature. Most of the time, the ligature material is not available during autopsy examination in hanging. Hence, the features of the ligature material are not submitted to systematic analysis. However, the type and position of the knot plays an important role in the mechanism of death and autopsy findings in hanging. Out of the total hanging deaths, complete hanging was seen in 67.7% of the cases, but a typical hanging was noted in only 10.2% of the cases. The commonest type of ligature material used for ligation around the neck was nylon rope followed by odhni and jute rope. The fixed knot was noted in 64.6% of the cases and a running (slip) in 21.3% of the cases. The commonest position of the knot was at nape of the neck, followed by the left side of the neck at mastoid process. The number of turns/loops of a ligature around the neck was one turn in 72.4% and two in 25.2% the hanging deaths. Most victims committed suicide by hanging in their homes, and the commonest ligature points were trees, flowed by beams and ceiling hook/fans.

A Rareposition in Partial Hanging - A Case Report

In hanging suspension of body may be complete or partial. Different positions of partial hanging are noted in the forensic literature.Here we report a case of 15 year old school going boy who committed suicideby hanging in an unusual way by schooluniform neck-tie as ligature material on the play ground slide. The victim was in lying down position with his whole posterior aspect resting on surface along with head on the play slide. Medico-legal autopsy was done in department of forensic medicineatShriVasantraoNaik Government Medical College, Yavatmal to confirm the cause, mode and manner of death.Medico-legal, legal and social issues related to this rare type of unusual partial hanging case arediscussed. Key worlds: unusual, partial hanging, playground slide, necktie.

An Epidemiological and Patho- Anatomic Profile of 246 Cases of Hanging -A Cross Sectional Study

This cross sectional study was done over a period of 10 years to study the epidemiological and Patho-anatomic findings in cases of death due to hanging. A total of 246 cases were studied and findings were as follows, victims aged 21–30 years constituted largest group 44.3% (Cases),56.09% (cases) were males, 54.47% (Cases) were married, place preferred for suicidal hanging were indoor in 99.59%(cases). soft ligature material used in 63.41%(cases). The Patho anatomic findings were, ligature material was present in 98.78%, it was above the level of thyroid cartilage in 75.72% cases, protursion of tongue was seen in 25.64% cases, salivary discharge in 30% of cases. No soft tissue hemorrhage, intimal tears of carotid artery, neither fracture of hyoid bone and thyroid cartilage were seen in these 246 cases.

Histopathological Study of Carotid Arteries in Deaths due to Hanging

We studied the influence of various parameters on carotid artery in cases of deaths due to hanging. In 60 hanging deaths autopsied, the various details were gathered, analyzed and interpreted. Histopathology examination revealed the incidence of carotid artery injury to be 47 % (28 cases). Out of these maximum cases (17%) showed disruption of intimal layer from medial layer followed by 15 % cases intimal tear, 8 % cases perivascular congestion and 7 % cases subintimal haemorrhages. We concluded that age, type of hanging, position of knot and ligature materials were the parameters which influence carotid artery injury.

A Study of Ligature Mark in Deaths due to Hanging in Warangal Area, Andhra Pradesh

Background Death due to hanging is one of the most common forms of suicide in most parts of the world. It is the commonest method of suicide in India, Canada, second most common method in USA and most common method of suicide in men in UK. The incidence of suicide in all metropolitan cities in India is on the rise. Their magnitude is also quite significant among the total number of deaths. Aims & Objectives To evaluate the types of hanging, the pattern of ligature mark and the type of material used as ligature in relation to the ligature mark. Material and Method The study is done on dead bodies that were subjected to post-mortem examination. The study included 100 cases out of 108 cases selected from both the sexes for statistics. Result The total of hanging deaths is 6.9%. The male to female ratio is 2:1 remains unaltered from previous studies. Age group is 21 years to 40 years rural area 54% outnumbered the sub-urban 24% and urban area 22%. Low socio economic status 65% ranged over middle class 25% and higher income 10%. Typical hanging is seen in 22 cases and atypical hanging in 88 cases. Partial hanging is seen in 68 deaths where as complete hanging is seen in 32 deaths. The ratio of male to female 2:1. Ligaturemark impression prominent in 94 percent deaths. In 6 cases ligature mark was faint. CONCLUSION Suicidal atypical hanging deaths are common. Ligature mark is prominently seen and Ligature Material was whatever available in the surroundings- rope, electric wires, loop of trousers, nawar patti, neck threads bed sheets, dupatta, sari etc. Language: en

An Epidemiological Study of Hanging Cases Brought to the Gauhati Medical College and Hospital Mortuary for Medico Legal Autopsy- A Retrospective Study

Hanging is a most common means of suicide. In this study during the period from July 2012 to June 2013, 11.40% of the death was due to hanging. The male to female ratio was 2.29:1 with 38.92% of the victim belongs to the age group 20–29 followed by 30–39 (18.04%). 54.11% of the victim belongs to lower class. About 25.63% of victims were mainly daily labourer followed by house wife 16.77%. Most of the victims were under matric 26.90% then illiterate 17.72%. Higher incident of hanging case was among married individual (61.07%). 87.03% cases were mainly Hindu followed by 11.08% of Muslim community. 50.63% cases occurred in the urban area. Majority of cases 85.75% occurs in the house and ropes (cotton) were commonly used ligature materials 24.05%). Majority of the knots were present behind the left mastoid (35.75%) followed by below the occiput (28.16%). 80% cases ligature was situated above the thyroid cartilage and 15% cases ligature was present over the thyroid cartilage and 5% cases ligature was present below the thyroid cartilage.

Socio-demographic profile of hanging cases at New Civil Hospital, Surat

Background: Violent asphyxial deaths are one of the important causes of death nowadays. For reasons not known to others, victims end their life by committing suicide. Hanging is one of the preferred mode of committing suicide, as it supposedly produces painless death as compared to others modes of suicide, and also because it produces instantaneous death. The present study is for lookinginto demographic profile of the victims of hanging for studying the predisposing factors, and to take preventing measures. Aims & Objectives: To analyze various demographic and social aspects of hanging. Materials and Methods: A profile of 87 cases of death due to hanging in the present prospective study was done at FMTD, GMC and NCH, Surat, between October 2011 and September 2013. The observations of the study were compared with previous studies. Results: In the present study, the incidence rate of hanging cases was 2.20%. The major age group involved was 21 to 30 years. Majority of hanging cases were found in males. Incidence of hanging was recorded high in married females compared to marriedmales. Majority of victims chose home to end their lives. Majority of the persons were non migrant in this study. Majority of victims had gained education more than secondary level. In most of the cases, total monthly income of family was less than 10,000. The most common ligature material used was dupatta. Conclusion: Hanging among male is more common than female. Married persons have more incidence of hanging. Hanging is more common in less educated persons. Low income is a risk factor for hanging. Persons prefer home for hanging over other places. Persons prefer soft, easily available material for hanging. So by identifying these risk factors we can initiate appropriate steps to reduce deaths due to hanging.

Injuries over neck in hanging deaths and its relation with ligature material: Is it vital?

Hanging is a common suicidal means adopted. Careful inspection and noting of ligature mark is a vital factor during medico-legal postmortem. Ligature material used by the deceased is an important factor causing ligature mark in hanging. Apart from the ligature mark there are other injuries over neck surrounding it, which are called as ‘peri-ligature injuries’. Peri-ligature injuries such as blisters, bruise, abrasion, etc. are influenced by different types of ligature material involved. These peri-ligature injuries are important for commenting on the antemortem nature of hanging in addition to other factors. Thus the present study on hanging deaths was carried out to see the relation of ligature material and different injuries occurring over the neck.

Multifactorial analysis of hanging deaths

Objective: The objective of this study was to analyze hanging deaths occurring in Imphal in relation to several factors associated with such deaths. Materials and Methods: This study was performed on 35 cases of hanging deaths brought for an autopsy to the mortuary of Regional Institute of Medical Sciences, Imphal. Factors associated with these deaths and post-mortem findings were recorded and statistically analyzed. Observation: It was observed that the most vulnerable age group was 21-30 years in both sexes. Nearly, 51.42% of the cases belonged to the lower socio-economic group; and the majority of the female victims were house wives (34.29%) who were going through marital disharmony. 82.86% of suicides by hanging occurred indoors and the bedroom was the preferred site in 18 cases (51.42%). The commonly used ligature materials were means which were easily available to the victim viz. nylon rope, chunni, etc. Petechial hemorrhage on the face and eyes were observed in partial hanging cases only. Conclusion: The findings of the present study will help in highlighting the prevailing scenario of hanging deaths in this state.

Pattern of Injuries to Neck Structures in Hanging—An Autopsy Study

One hundred eighty-nine cases of known dead bodies brought for medicolegal autopsy with alleged history of hanging were studied at the Department of Forensic Medicine, State Medico Legal Institute, Government Medical College, Thiruvananthapuram, Kerala, India. All the findings noticed during detailed external examination and flap dissection of the neck were analyzed with special emphasis on correlation between the external and internal injuries on neck.There was a preponderance of males in the study group (70.9%), majority of them being middle-aged (64.9%). Among females, the major group was composed of adolescents and young adults (72.8%). Easily available materials were used as ligature materials. Soft materials such as saree, shawl, lungie, and so on were used as ligature by 47% of victims and hard materials such as coir rope, plastic rope, telephone cable, and so on were used by 29% of victims. Oblique ligature mark was noted in 94.2% of cases. The ligature mark was noncontinuous in 78% of cases. Horizontal ligature marks were noted in cases of partial hanging.Rupture of muscle fibers at the lower attachment of sternomastoid was seen in 19.6%, and carotid intimal tear was seen in 1.1% of cases. Fracture of hyoid bone at their greater horns was seen in 2.7% and thyroid cartilage in 5.3% of cases. Vertebral fracture and dislocation were noted between third and fourth cervical vertebrae in 1.6% of cases. Neck skeleton injuries were noted in persons older than 38 years.

Suicidal strangulation by plastic lock tie

A case of self-strangulation with a rare kind of ligature material is reported and discussed. The merit of the case lies in the ‘self-retaining’ nature of the ligature material deployed. The case subject was a 50 year old man found dead in an open field with a unique ligature material of ‘plastic lock tie’ in-situ at neck. Forensic autopsy revealed ligature mark above the level of thyroid cartilage, evidence of bleeding through mouth and nostrils along with generalized features of congestion. Toxicological analysis of blood and viscera detected organophosphorus poison in stomach contents. Cause of death was opined as mechanical asphyxia due to compression of neck by self-strangulation. The importance of a scrupulous forensic autopsy supplemented by ancillary investigations and circumstantial evidences are highlighted. The relevance of the visit of autopsy surgeon to the scene of occurrence is emphasized.

Use of Roeder knot with vicryl-reel ligature for laparoscopic appendicectomy: have we forgotten how to tie knots?

Conventionally, control of the appendix base in laparoscopic appendicectomy is achieved with Roeder knots. These are commonly delivered using pre-tied ligatures of 2/0 polyglycolic acid. In our centre, Surgiwip™ ligatures (Covidien, Mansfield, MA, US) cost £13.50 each, bringing the cost of this practice to £40.50 per case. A cheaper alternative is to use the same ligature material on a reel and to hand tie each Roeder knot, advancing each knot simply with laparoscopy forceps. Three Roeder knots can therefore be obtained from a single reel. Using a Polysorb™ reel (Covidien), this costs £2.97 for three Roeder knots, saving £37.53 per case.

Knotless Noose in Hanging: A Case Report and Review of Literature

Knot in a noose encircling the neck has its own forensic significance in cases of hanging. The pattern of ligature mark and the mechanism of death in hanging with different knot positions are found in literature. However, when such knots are absent in noose, the post-mortem findings are different, which needs to be discussed. We report one such case of hanging, where neck compression had occurred by a ligature material with a loop that did not encircle the neck and did not bear a knot. The findings are discussed along with the mechanism of death in such cases along with a review of literature.

The Influence of Different Ligature Materials on Frictional Coefficient of Slided Bracket on Arch Wire

Aims: To evaluate the frictional coefficients of different ligature materials with combination of stainlesssteel arch wire and bracket. Materials and methods: Ten ligatures were used for each of stainlesssteel, elastotomeric and teflon utilized with stainless steel arch wires and brackets. A simulated halfarch fixed apparatus was designed for measuring the static and kinetic frictional coefficient of the slidebracket incorporated with tensile testing machine. The data were analyzed by using the descriptive andvariance analyses of tests (ANOVA and Duncan’s Multiple Range test at p≤ 0.05) to reveal the significantdifference of the frictional coefficient among the three types of ligature materials. Results: It wasdisclosed that the elastomeric ligature had a very highly significant increased mean value of the staticand kinetic frictional coefficients as compared with other ligatures. Conclusions: The elastomeric ligatureis not recommended for use with sliding stainless steel bracket on the arch wire.