Hyoid fracture and judicial outcomes in alleged strangulation deaths: Mixed-methods analysis of Indian High Court and Supreme Court judgments (2024–2025)

Background Hyoid bone findings are frequently discussed in court judgments involving alleged strangulation/neck compression, yet their documentation and judicial interpretation vary. We examined whether hyoid fracture status is associated with judgment outcome and how hyoid-related arguments are used in judicial reasoning. Methods A mixed-methods study was conducted using Indian High Court/Supreme Court (HC/SC) judgments (2024–2025) retrieved from Indiankanoon.org . Quantitative analyses were performed on strangulation/neck compression judgments ( n = 370). Judgment outcomes were categorised and collapsed into accused-favourable versus prosecution/anti-accused-favourable outcomes. Victim-level analysis included 376 victims. Associations were examined using chi-square/Fisher's exact tests with odds ratios. A qualitative thematic synthesis was undertaken on the broader HC/SC hyoid corpus ( n = 500) to contextualise quantitative findings; key themes were summarised. Results Accused-favourable outcomes were less frequent in cases with documented hyoid fracture than in intact/not-mentioned cases (47.2% vs. 62.7%; OR = 0.53, 95% CI: 0.35–0.81; p = 0.003). In accused-side applications, high weightage to literature-linked hyoid arguments was associated with lower accused success in fracture cases (OR = 0.40) but higher success in intact/not-mentioned cases (OR = 2.39), suggesting effect modification by fracture status. Victim-level analyses showed fracture was more frequent when manual/throttling was alleged compared to ligature strangulation (OR = 2.17, 95% CI: 1.34–3.52; Fisher's exact p = 0.0022). Qualitative synthesis identified recurrent judicial reliance on hyoid fracture as a decisive sign, variable use of literature, and documentation gaps influencing interpretation. Conclusions Hyoid fracture documentation is associated with judicial outcomes and shapes argumentation strategies. Standardised forensic documentation and cautious interpretation of isolated hyoid findings are warranted.