Study of Ligature Mark Patterns in Cases of Hanging: An Autopsy-Based Observational Study

Abstract

Introduction: Hanging is one of the most common methods of suicide worldwide and constitutes a significant proportion of medicolegal autopsies. The ligature mark on the neck is the principal external finding and serves as the cornerstone of postmortem diagnosis in hanging deaths. The morphological characteristics of the ligature mark, including its position, direction, continuity, depth, and associated peri-ligature injuries, provide crucial information regarding the type of hanging, ligature material used, and mechanism of death. This study aimed to evaluate the patterns of ligature marks in autopsy-confirmed cases of death by hanging and to correlate these patterns with the type of ligature material, type of hanging, and position of the knot. Material and Methods: This cross-sectional observational study was conducted at the PRM Medical College & Hospital, Baripada and SJ Medical College & Hospital, Puri from January 2022 to December 2025. A total of 200 autopsy-confirmed cases of death by hanging were included. Cases were selected based on predefined inclusion and exclusion criteria. Data regarding demographic profiles, ligature material, type of hanging, knot position, and detailed ligature mark characteristics were recorded using a structured proforma and analyzed statistically using SPSS version 25.0. Results: Among the 200 cases studied, males constituted 74% (n=148) and females 26% (n=52). The majority of victims belonged to the 21–30 year age group (36.5%). Complete hanging was observed in 62% of cases and partial hanging in 38%. Rope was the most commonly used ligature material (38.5%), followed by dupatta/scarf (22%). The ligature mark was obliquely placed in 82% of cases and above the thyroid cartilage in 76.5%. A non-continuous mark was found in 72% of cases. Slip knots were used in 58% of cases. Imprint patterns corresponding to the ligature material were observed in 64% of cases. Hyoid bone fracture was noted in 8.5% and thyroid cartilage fracture in 12% of cases, with a statistically significant association with age above 40 years (p<0.05). Conclusion: The study demonstrated that the characteristics of ligature marks in hanging are significantly influenced by the type of ligature material, the type of hanging (complete vs. partial), and the position of the knot. A thorough and systematic examination of the ligature mark remains the most important component of postmortem examination in hanging deaths and is indispensable for accurate medicolegal diagnosis.