Sub-occipital ligature knot in a case of long drop suicidal hanging with rare autopsy finding of cervical spine fracture

Abstract

Background: Hangman’s fracture (Fracture of cervical vertebrae) in hanging is usually described into the context of judicial type of hanging where the individual is dropped from a calculated height with sub-mental or sub-aural position of ligature knot. Such a long drop with typical upper cervical vertebral fracture is a rare entity in a case of suicidal hanging. Case presentation: We have described such a case where an average built deceased weighing 62 kg hang himself with a nylon rope by jumping from a branch of tree with a drop length of 6.3 m, which was sufficiently long enough to cause soft tissue injuries, transection of larynx along with fracture and dislocation of cervical spine at C2-C3 level contrary to the fact that position of ligature knot was in sub-occipital area. Hence, this rare case is discussed with reference to the probable mechanism involved in causation of such internal injuries. Conclusion: In our case of long drop hanging, we found fracture of cervical spine when ligature knot was placed at sub-occipital position which is a rare autopsy finding. We also noticed deep laceration of skin and transection of larynx as extremely rare finding in hanging caused by flexible and blunt nylon rope used as ligature material.