`

JOURNAL READING
An Autopsy Study of Death Due to Suicidal Hanging
Sex Identification and Reconstruction of Length of Humerus from Its Fragments
Oleh:

Tegar Pamungkas (201610401011014)

Pembimbing:
dr. Liauw Djai Yen

SMF ILMU KEDOKTERAN FORENSIK

FAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH MALANG
RUMAH SAKIT BHAYANGKARA PORONG
2016

1
 DAFTAR ISI

Halaman Sampul 1
Daftar Isi 2
An Autopsy Study of Death Due to Suicidal Hanging...3
Terjemahan An Autopsy Study of Death Due to Suicidal Hanging...11
Sex Identification and Reconstruction of Length of Humerus from Its
Fragments15
Terjemahan Sex Identification and Reconstruction of Length of Humerus
from Its Fragments..24

2
Egyptian Journal of Forensic Sciences (2016) 6, 248254

HOSTED BY Contents lists available at ScienceDirect

Egyptian Journal of Forensic Sciences

journal homepage: http://www.journals.elsevier.com/egyptian-journal-of-forensic-sciences

An autopsy study of death due to Suicidal Hanging

264 cases

Dinesh Rao *

Department of Forensic Medicine, SIMS, Bangalore 560090, India

Received 19 March 2014; revised 8 December 2014; accepted 10 January 2015

Available online 7 February 2015

KEYWORDS Abstract The present study was carried out between 2010 and 2013, a total of 7968 Autopsies were
Hanging; conducted of which 3.31% (n 264) cases were deaths due to hanging. The most preferred ligature
Ligature mark; materials were Stole (n 79) and Bed spread/Sari (n 68). In 88% of the cases, hanging was complete.
Asphyxia; Females (n 136) and males (n 128) were equally affected. The major age group involved in both the
Neck; sexes was of 3140 years, contributing to 50.76% (n 136) of the self suspension. In 80.58% (n 213)
Knot; of the incidents, ligature mark showed discontinuity (incomplete). A Slip type of knot was used in
Fracture majority of the noose, contributing to 97.73% (n 258) of the suspensions. In 87.88% (n 232) of
hanging an oblique shaped ligature mark was noticed. The horizontal and near oblique ligature marks
were seen only in cases of partial suspension. In 95.45% (n 252) of the cases, the ligature mark showed
blackening of the skin (friction burn). Only 4.54% (n 12) showed intact skin. The outer layer of the
skin over the ligature mark showed displacement in majority of the cases. Married victims contributed to
70.45% of cases. Domestic issues were the commonest reason (n 82) for self suspension, of which
female (n 68) formed the majority of victims. In 70.83% (n 187) of cases damage to neck muscle
fibers and hemorrhage at the Sternal end of the Sternocleidomastoid muscle were present. In 85.61% (n
226) of cases the cervical vertebra was intact. In 52.27% (n 138) of the cases the internal carotid
artery showed transverse tear. In 99.42% (n 248) cases the thyroid cartilage was found intact. The
hyoid bone was damaged in 6.06% (n 16) of the victims. Majority of the victims, 59.09% (n 156)
belonged to low socioeconomic class.
2015 The International Association of Law and Forensic Sciences (IALFS). Production and hosting by
Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).

3
1. Introduction

1
Death due to hanging is not unusual across the world, this makes the majority of Asphyxia deaths. Many a times

suspicions are raised with the manner of deaths in cases of sus-pension of the body (complete and partial) and position of lig-ature marks,
resulting in punishment of Innocent or sparing the Guilt. Hence this study is conducted to study in detail the Autopsy findings of deaths
2
due to hanging so as to put an end to these speculations surrounding the deaths in hang-ing. This study helps to differentiate self
suspension from other forms of hanging. This is a prospective study, conducted between 2010 and 2013. In this study only cases of
Suicidal

http://dx.doi.org/10.1016/j.ejfs.2015.01.004
2090-536X 2015 The International Association of Law and Forensic Sciences (IALFS). Production and hosting by Elsevier B.V. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Autopsy study of death due to suicidal hanging 249

Hanging findings are analyzed and studied thoroughly, other
manners of suspension are excluded. All the information related
to the Circumstances was collected from the Police and from the
deceaseds family members. All factors deemed important to
conclude Suicidal Hanging had been considered as the elements
of the study (Fig. 1).
2. Materials and methods
a. The study was conducted between 2010 and 2013. A total
of 7968 Autopsies were conducted of which Sui-cidal
Hanging contributed to 3.31% (n 264) of cases.
b. All the cases referred to the Legal Medicine Department
for Autopsies were the material source for the study.
c. Crime scene examination was done in a few cases and in
majority of the cases crime scene photographs and inves-
tigating officer records were the inputs.
d. Autopsies were conducted with enmasse removal of
Thoracic and Abdominal Organs and the neck was the last
to be dissected after removal of the Cranial Structures.
e. External findings of the ligature mark were described,
photographed and sketched.
f. Internal findings of the neck by layer by layer dissection of
the neck.
g. Carotid artery damage to the Intimae was by gross
examination and Toluidine blue dye examination.
h. Cervical vertebra fracture, thyroid, cricoid and hyoid bone
fractures were confirmed by Radiological examina-tion and
further confirmed through the dissection method.
i. The ligature material was always brought along with the
dead body with the noose and knot intact (Table 1).
3. Results
1. The commonest ligature materials of choice were Stole (n
79; 29.92%) and Sari (n 68; 25.76%). The least common
ligature material of choice was Waist Belt (n 2; 0.76%). The
other materials used were Plastic Rope (n 28; 10.68%), Bed
Sheet (n 22; 8.33%) and Cotton Rope (n
19; 7.20%) in decreased order of appearance. The major-ity
of the noose had a Slip type of knot contributing to
97.73% (n 258) of the suspensions and only 2.27% (n 06)
showed fixed knot (Table 2).
2. Females (n 136) and males (n 128) were closely the vic-
tims of self suspension. The major age group affected in both
the sexes was in the range of 3140, contributing to 50.76% (n
136) of the self suspension. The age group pre-ferred for self
suspension was between 21 and 30 years, con-tributing to
31.06% (n 82) of the cases. The least affected ages were in
children less than 10 years (n 01). There were no incidents
reported above 60 years of age (Table 3).
3. In 80.58% (n 213) of cases the ligature showed discontinu-
ity (incomplete) and only 19.32% (n 51) showed complete
ligature (Continuity) mark. The oblique shape of ligature mark
was present in 87.88% (n 232) of hanging. 6.82% (n 18) of
cases showed horizontal ligature mark in partial suspension
and 5.30% (n 14) of cases showed near oblique
ligature mark. The horizontal and near oblique ligature marks
were seen only in cases of Partial Hanging. In

COIR ROPE
COTTONE ROPE
PLASTIC ROPE
PLASTIC THREAD
SAREE
STOLE
SHOE LACE
BED SHEET
WAIST BELT

4
 TOWEL FIXED KNOT
SLIP KNOT

Figure 1 Types of ligature material and knot type.

Table 1 Age and sex distribution.

<10 years 1120 2130 3140 4150 5160 >60
Age 01 21 82 134 24 02 00
Male 01 12 18 86 09 02 00
Female 00 09 64 48 15 00 00
Total 01 21 82 134 24 02 00
Total: Male-128; Female-136.

5
250 D. Rao

Table 2 Morphology of the ligature mark. Table 4 Motivating Factors.

Ligature mark No. Percentage (%) Motivating factors Male Female
Complete mark 51 19.32 Domestic (Dowry related) 14 68
Incomplete (Discontinuity) 213 80.68 Love relationship 15 49
Oblique shape 232 87.88 Financial 32 04
Horizontal shape [partial suspension] 18 6.82 Education/career 10 08
Near oblique shape [partial suspension] 14 5.30 Work related 08 02
Above the thyroid cartilage 218 82.58 Disease related 22 32
Over the thyroid cartilage 27 10.22
Below the thyroid cartilage 19 7.20
Abrasion/Excoriation 249 94.31
Grooving 249 94.31
Leathery hard and pale 249 94.31 Table 5 Internal findings in the neck.
Color change blackening 252 95.45 Neck tissue No. Percentage (%)
Heaping of Epithelium in margins 249 94.31
Right side accumulation of Epithelium 162 61.36 Sternocleidomastoid 187 70.83
Left side accumulation of Epithelium 84 31.81 Thyroid cartilage 2 0.76
Undisplaced epithelium 18 6.82 Hyoid bone 16 6.06
Intact skin 12 4.54 Cricoid cartilage 00 00
Carotid artery 126 47.73
Cervical vertebra 38 14.39

Table 3 Type of hanging, socioeconomic class, places of self

suspension and marital status. major share of victims. This was followed by love/relation-
Complete Hanging 232 88% ship related issues (n 64), here too females formed the major
Partial Hanging 32 12% part of the victims (n 49). The other major contrib-uting
Married 186 70.45% factors were the disease conditions (n 54) of the vic-tims
Unmarried 78 29.55% compelling to hanging. Other factors like financial issues (n
Out of house 26 9.85% 38), education/career issues (n 18) and work related issues (n
Inside house 242 91.67% 10) contributed to self suspension.
Work place 06 2.27%
Low income class 156 59.09% 6. 70.83% (n 187) of cases showed contusion, damage to
Middle income class 242 91.67% muscle fibers and hemorrhage at the Sternal end of the Ster-
High income class 18 6.82% nocleidomastoid muscle. 85.61% (n 226) of cases showed
the cervical vertebra intact, only 14.39% (n 38) showed
fracture involving cervical vertebra. In 52.27% (n 138) of
the cases the internal carotid artery showed transverse tear.
94.31% of cases the ligature mark (n 249) was character-
99.42% (n 248) cases showed intact thyroid cartilage, only
ized by Excoriation (Abrasion), Grooving, Leathery hard
0.76% (n 02) showed damage to thyroid cartilage, similarly
consistencies, Paleness and showed heaping and displacing of
in 93.94% (n 248) of cases the hyoid bone was intact. The
the superficial part of the skin around the ligature mark. In
hyoid bone was damaged in 6.06% (n 16) of the victims.
82.58% (n 218) of cases the ligature marks were situ-ated
None of the victims showed damage to the cri-coid cartilage in
above the thyroid cartilage. Only 7.20% were situated below
self suspension.
the thyroid cartilage, whereas 10.22% (n 27) were situated
over the thyroid cartilage. In 95.45% (n 252) the ligature
mark showed blackening of the skin (friction burn). Only
4.54% (n 12) showed intact skin. The dis-placed epithelium 4. Discussion
was unidirectional, 162 cases showed rightward displacement
and 84 cases showed leftward dis-placement, and 18 showed The present prospective study was conducted between 2010 and
no sign of displacement of the epithelial tissue (Table 4). 2013. A total of 7968 cases were autopsied of which deaths due to
hanging comprised 3.31% (n 264) of Autopsies. Sim-ilar studies
3
4. Of the total 264 cases of self suspension, 88% of the hang-ing conducted by Hassan et al. in a two year period in Kuwait
were complete and 12% were due to Partial Hanging. Majority reported a total of 118 cases. In another study con-ducted by
of the victims, 59.09% (n 156) belonged to poor or low 4
Kumar and Verma in Lucknow (India) a total of 4405 cases were
socioeconomic class, and 34.09% (n 90) belonged to average autopsied in a five year period of which only 10% of cases were
class. Only 6.82% (n 18) were from the High Income Group. 5
due to hanging. Dean et al. had studied on 229 cases. Hence
In 91.67% (n 242) of cases, the incidents occurred inside the regional socioeconomic and Cultural fac-tors play an important
house, the least preferred place was work place in 2.27% (06). role in Suicidal Hanging. Hence the present study is unique due to
And the other preferred place was outside the House in 9.85% its highest number of case stud-ies as compared to the other
(n 26). Majority of the victims were married comprising studies elsewhere in the world. The present study is compared
70.45% of the cases and only 29.55% of the cases were with the other studies con-ducted elsewhere in relation to various
unmarried (Table 5). incidences surrounding Suicidal Hanging in Table 6. In the
5. The domestic issues were the commonest factor responsible (n present study the common-est choice of ligature material used
82) for hanging, of which female (n 68) formed the was female dress (soft)

6
 Autopsy study of death due to suicidal hanging
Table 6 Comparison of results of the present study with similar studies conducted in different parts of the world.

Author Place of study No. of Ligature material Ligature, knot and Age Sex Ligature mark Site of ligature Skin and ligature Type of Suspension Marital status Socioeconomic Sternocleidomastoid Thyroid/cricoid/hyoid Internal carotid Cervical
cases its position shape mark mark class bone artery vertebra

Present Study Jamaica/India 264 Stole (n 79; Slip knot in 97.73; 2130 years, Females-51.5% 87.88%-oblique 82.58%-Above the 94.31%- 88% of the hanging Married- 59.09% (n 156) 70.83% 0.76% thyroid 52.27% 14.39%(n 38)
29.92%) and Saree Fixed knot in contributing to shape; 6.82%- thyroid cartilage. Excoriation, were Complete and 70.45% belonged to Poor or cartilage;6.1%; hyoid
(n 68;25.76%) 2.27% cases 31.06% Horizontal 10.22% across the Grooving, Leathery 12% were due to Low socioeconomic bone
Suspension, thyroid cartilage hard consistencies, Partial Hanging class, and 34.09%
remaining near Paleness and (n 90) belonged to
oblique suspension showed heaping Average class. Only
and displacing of 6.82% (n 18) were
the epidermis. from the high
80.58%- Income Group
Discontinuity
95.45%- showed
blackening-friction
Kurtulus et al. Turkey 108 52.9% -Typical 40.97 17.41 years 71.6% 67.6%
1
Jayaprakash , India 189 49%[saree, shawl, Middle age in 70.9% 94.2%-Oblique 19.6% thyroid cartilage-5.3%; 1.1% 1.6%
Sreekumari lungie] 29%[ coir 64.9% 78%-Non hyoid bone-2.7%
rope, Plastic Rope, continues
telephone cable]
Abd-Elwahab et al. Kuwait 118 21 and 50 years 73%
(87.3%) 3rd
Decade-43%
Dean et al. USA 229 Partial suspension-
83.4%
Al Madni et al. Saudi Arabia 133 21 and 50 years 86.46%
(88.7%), 4th
Decade (about
36%)
Pradhan et al. Nepal 44 47.72%-ROPE; 47.37% Partial suspension
31.81%- used 56.81%
shawl; 9.09% -used
Sari; Belt-2.27%
Sharma et al. India 72 Sari (32%) or Atypical in 88% 2130 years-57% 63% Above thyroid Complete 54% 21% cases
chunni (24%) cartilage-58% cases suspension-68%
*
Saisudheer , India 200 86%-the ligature 11%-Typical 32% 88% the mark was 38%-Complete Complete 82% Married Middle Income 28% 4%
Nagaraja cases material was soft hanging 59%-Slip present above suspension-64% Group-78%. Lower
knot; Fixed knot- thyroid cartilage, in income group 34
32% 20 cases (10%) it (17%) and least
was present over common is in
the thyroid higher income
cartilage group 04 (2%)
Olive Bennewith, UK 162 Rope-98.8% Cord- Males (40.6 years) Complete
et al. 49.4%Belt -13.1% and females suspension-52%
Electric cable- (42.2 years)
11.9%
Suminska - Poland 61 Males-89%
Ziemann,
Bloch-Bogusawska
1
Nikolic , Zivkovic Serbia 3.3%
Charoonnate N Thailand 20 60% typical 42.40 years Complete 25%
et al. Suspension-45%
NikolicS et al. Belgrade 557 Average age of 74%-Males 15.1% had only hyoid
52.4 17.8 years bone fracture, 26% had
only thyroid cartilage
fracture and 16.2% had
both types of injury at
the same time
Hejna Czech Republic 178 16.1%
Suarez-Penaranda Spain 228 75.3% 9.1%
et al.

251
7
252
material [(Stole (n 79) and Sari (n 68)] constituting to 55.68%
(n 147) cases and the least preferred choice was the Waist Belt,
reported in only 2 cases (0.76%), similar were the observations
6 7
made by Jayprakash and Sreekumar Sharma et al. , they had
opined 47% and 56% of their victims respec-tively preferred Soft
ligature material like sari, Stole, shawl. These results were
8 Obliquity is maintained in Complete Hanging. In Par-tial Hanging
contrary to the observations made by Prad-han et al. wherein
they had observed that only 9.09% (n 4) used sari. Whereas the
9 situated horizontally whereas in fixed knot with partial suspension
study conducted by Saisudheer and Nagaraja concluded with
86% of Soft material used for liga-ture. In the present study hard
ligature materials like Plastic Rope, Coir Rope and Cotton Rope
comprised 22.72%, similar were the observations made by
6 neck. The morphology of the liga-ture mark highlighted that
Jayprakash and Sreekumar. This wide nature of deviations in the
choice of ligature mate-rial depends on the dressing fashion of the
population and occupation. It is observed that Sari in the southern
part of India and Stole [Chunni] among females from northern
India are widely used and are easily available in the house and
hence the obvious choice in these regions. Whereas in the UK
10
(Bennewith) the commonest choice was hard materials like
Rope, Belt, Cord and Cable, soft materials like Sari or Stole were
least found in that region. Hence factors like sex of the victim,
culture, geographic location and place of the act play an important
role in this. The present study also indicated the fact that 88% of
the hangings were complete [n 232], these results are close to
7
the observations made by Sharma et al. and Saisudheer and
9 Suspension by a ligature around the neck. This also indirectly
Nagaraja, in their study, 68% and 64% of the cases respectively
were due to Complete Hang-ing, however these observations are
5 8
contrary to those made by Dean et al. and Pradhan et al. . They
observed that 83.4% [n
229] and 47.37% of their cases were due to Partial Hanging, all
these observations highlight the regional influence, lifestyle and
to a certain extent the type of residence. In the present study
females and males were equally affected contributing to 136 and
128 cases respectively, and the majority belonged to 3140 years
(50.76%; n 136) and the least affected age group was from
those below the first decade and above 6th decade, these results
are contrary to the claims made by Jayp-rakash and Sreekumar
6 cases (31.06%), similar were the observations made by
7 Saisudheer and Nagaraja , who concluded that 18% of cases were
and Sharma et al. wherein, the male to female victim ratio was
2:1. However their observations clo-sely matched with the age
11
group involved. The observations made by Kurtulus et al.,
6 3
Jayaprakash and Sreekumaran, Abd-Elwahab et al., Suminska-
12 13
Ziermann and Al Madni et al. are more deviating as they
found that the Males were more affected than females in the ratio
3:1. This wider varia-tion in the sex group is possibly due to the
cultural, religious, economic and lifestyle factors driving the
individual to Suicidal Hanging. In the present study, 80.58% (n
213) of the victims ligature mark showed discontinuity
(incomplete), similar were the observations made by Jayprakash
6 9
& Sreekumar and Sai-sudheer & Nagaraja . They had concluded
that 78% and 82% of their victims, respectively showed
incomplete ligature marks. In the present study the most preferred
knot was the Slip knot, contributing to 97.73% (n 258) of cases.
7 manipulations to com-mit the act apart from non interference in
These results were contrary to those made by Sharma et al
wherein they had concluded 71% of their victims had fixed knot.
9
The observation made by Saisudheer and Nagaraja was close to
the observations made in the present study. Obliquity of the
ligature mark was noticed in 87.88% (n 232) of cases and
Horizontal ligature mark was noted in 6.82% (n 18) of cases,
similar were the observations made by Jayprakash and Sreeku-
6
mar, however the Horizontal ligature mark was noted in
8
D. Rao
Partial Hanging. The type of knot, continuity of mark and
completeness of hanging are important in determining the lig-
ature mark over the neck. In a Complete Hanging wherein the
body is completely suspended with a slip knot the ligature mark
will be oblique and continues without disruptions, whereas in
fixed knot non continuity of the mark is common though
with Slip knot the continuity is maintained but the mark is
horizontal mark is present over front of the neck and missing over
the nape of the neck. Hence the type of knot and type of
suspension determine the ligature mark and its continuity over the
94.31% (n 249) of the ligature mark showed grooving, contrary
9
to the claims made by Saisudheer and Nagaraja wherein they had
observed grooving in 54% of their cases. In the present study a
unique pattern was noticed with grooving that the grooving was
associated with heaping up of the epithelium due to displacement
of the superficial skin in a directional fashion.
Majority of these displacements were toward the right side
neck (n 162) and in 18 cases there were no such displacements
observed. The displacement was due to the friction movement of
the ligature against the skin surface of the neck during the process
of decorticate and decerebrate rigidity during the pro-cess of
confirms the ante mortem nature of Suspension, however further
study in this area is required. The blackening or darkening of the
displaced skin noticed in 95.45% (n 252) of cases was due to
the heat generated during the friction of ligature material against
the skin surface. The author considers these observations as one
of the factors in determining the ante mortem nature of hanging;
these observations were not found in similar studies done
elsewhere. 70.45% of the victims were married, similar were the
9
observations made by Saisudheer and Nagaraja wherein 82% of
his victims were married. The major motivating factors observed
in the study were Domestic/Family related issues comprising 82
9
due to family related issues. The other major factors were the dis-
ease conditions contributing to self suspension, comprising
20.45% (n 54) of cases. These observations were contrary to the
9
claims made by Saisudheer and Nagaraja they had claimed 6%
of their victims had died due to diseased condi-tions. Other
factors like relationship crisis (n 49), financial worries (n 38),
career issues (n 18) and work stress (n 18) also contributed to
the cause. Hence the psychological state, economic state of the
individual and his health issues are the major driving force behind
Suicidal Hanging. Since these issues are closely associated in
married individuals, Sui-cidal Hanging is common among them.
The most preferred Places to commit the act in 91.67% (n 242)
of cases were the places of residence, similar were the views of
14
Uzun et al. . In their study of 761 cases, 634 victims preferred
places of res-idence. The reason is privacy and easy
the process of Suicide. In the present study, 82.58% (n 218) of
the victims had their knots over the sides of the neck (atypical
9
hanging), similar were the views of Saisudheer and Nagaraja and
7
Shar-ma et al. who had opined that 89% and 88% of the cases
respectively, were Atypical Hanging [knot over the sides of
Autopsy study of death due to suicidal hanging 253

6 19
neck]. This is possibly due to the victim tying the noose around Sreekumar and Nikolic, Zivkovic claimed 1.6% and 3.3% of
his neck during the time of suspension and then jumping over it, victims with cervical fracture. These wide variations in the
the other possibility is that the knot position changing after Incidences are possibly due to factors like age of the victim,
suspension during the terminal phases of hanging. The major-ity Weight of the victim, type of suspension and height of suspen-
of the ligature marks over the neck were situated above the sion. The study highlights the influence of regional, religious,
thyroid cartilage in 82.58% (n 218) of cases, whereas in only cultural, socioeconomic factors and demographic factors
7.20% of cases the ligature mark was situated below the thy-roid responsible for Suicidal Hanging. It also encourages further
9
cartilage, similar were the views of Saisudheer and Naga-raja research into these factors so as to prevent the incidences of
who in their study observed that 88% of their cases showed the Suicidal Hanging.
marks above the thyroid cartilage, however the views expressed
7
by Sharma et al. were contrary, in their study they had observed Conflict of interest
that in 58% of their cases the ligature marks were situated above
the thyroid cartilage. The presence of lig-ature mark above the
thyroid cartilage is due to the yielding soft tissue between upper The present study has no financial or personal relationship with
bony margin of the jaw and the lower protruding thyroid cartilage any person or organization.
besides the concentration of a lar-ger force on small area of the
neck. The study of neck struc-tures indicated that the Funding
Sternocleidomastoid muscle was involved in 70.83% (n 187) of
7
cases, similar were the views of Sharma et al. , however these None.
observations were contrary to the claims made by Jayprakash and
6
Sreekumar, who had concluded that only 19.6% of their cases
showed damage to the Sternocleidomastoid fibers, however they Ethical approval
had also indi-cated that 1.1% of the internal carotid artery showed
intimal tears which is contrary to the observations made in the
present study wherein 52.27% of the victims showed intimal tears
15 16
in the carotids. Suarez-Penaranda, Hejna and Jayprakash
6
and Sreekumar, made contrary claims to the present study. They
observed that 9.1%, 16.1% and 9.1% of cases respec-tively had
intimal tears of carotid. In cases of hanging and more preferably
in Complete Hanging there is always the Ster-nocleidomastoid
muscle subjected to Shear movement from external large
indenting pressure on its belly causing a tear of its attachments
from the sterna end besides this, the con-stricting force squeezes
the impending carotid artery causing sudden constriction of the
wall and its rupture. Other factors like the decorticate, decerebrate
and conclusive phase on the ligature also contribute to this
process. This may not be the case in all Partial Hanging wherein
part of the body force acts on muscles and vessels. The present
study also highlighted the fact that in majority of the victims,
Thyroid [99.42%] and Hyoid [93.94%] bones were unaffected,
6
similar were the views of Jayprakash and Sreekumar, Nikolic et
17 18 9
al., Charoonnate et al. and Saisudir and Nagaraja wherein
their observations are close to those made in the present study.
These observa-tions are disputed by those made by Suarez-
15
Penaranda wherein he observed that 75% of the victims had
fractures involving the thyroid and hyoid. This is because of the
fact that majority of his victims were in 4th and 5th decade of life
wherein the bones are ossified leading to the fracture unlike the
present study wherein the majority of the victims were between
21 and 30 years. The other factors like height of suspension and
type of hanging also play an important role. The majority 59.09%
(n 156) of the victims in the present study belonged to the low
socioeconomic group, contrary to the claims made by Saisudheer
9
and Nagaraja, who had observed that 78% of their victims
belonged to the Middle income group. In the present study 14.4%
of the cervical vertebra showed fractures and observations
11
contrary to those made by Kurtulus et al. They observed 67.6%
of their victims with cervical vertebra fracture. But the study
conducted by Jayaprakash and

9
Necessary ethical approval was obtained from the institute
ethics committee.
Acknowledgements
Legal medicine unit, Ministry of National security, Kingston
Public Hospital, Roberts Funeral Home, Bureau of Special
Investigation, Major Investigation Team.
4. Kumar S, Verma A. A study of elderly unnatural deaths in
medico-legal autopsies at Lucknow locality. Med Sci Law 2013
Oct 28.
5. Dean DE, Kohler LJ, Sterbenz GC, Gillespie PJ, Gonzaga NS,
Bauer LJ, et al. Observed characteristics of suicidal hangings: an
11-year retrospective review. J Forensic Sci 2012 Sep;57(5):
122630.

6. Jayaprakash S, Sreekumari K. Pattern of injuries to neck structures

References
1. Kannan K, Mathiharan. Modis Text Book of Medical Jurispru-
dence and Toxicology. 24th ed. LexisNexis Publishers. pp. 445
475.
2. Pekka Saukko, Bernard Knight. The path physiology of Death;
Knights Forensic Pathology. 3rd ed. Arnold and Oxford Press. pp.
383392.
3. Abd-Elwahab Hassan D, Ghaleb SS, Kotb H, Agamy M,
Kharoshah M. Suicidal hanging in Kuwait: retrospective analysis
of cases from 2010 to 2012. J Forensic Legal Med 2013
Nov;20(8): 111821.
10. Bennewith Olive, Gunnell David, Kapur Navneet,
Simkin Sue, Sutton Lesley, Hawton Keith. Suicide by
hanging: multicentre study based on coroners
records in England. Br. J. Psychiatry 2005;186:260
1.
in hanging-an autopsy study. Am J Forensic Med Pathol 2012
Dec;33(4):3959.
7. Sharma BR, Harish D, Sharma A, Sharma S, Singh H. Injuries to
neck structures in deaths due to constriction of neck, with a special
reference to hanging. J Forensic Legal Med 2008 Jul;15(5): 298
305.
8. Pradhan A, Mandal BK, Tripathi CB. Hanging: nature of ligature
material applied and type of hanging according to point of
suspension. Nepal Med Coll J 2012;14(2):1036.
9. Saisudheer T, Nagaraja TV. A study of ligature mark in cases of
hanging deaths. Int J Pharm Biomed Sci 2012;3(3):804.
254
10.

11. Kurtulus A, Yonguc GN, Boz B, Acar K.

Anatomopathological findings in hangings: a
retrospective autopsy study. Med Sci Law 2013
Apr;53(2):804.
12. Suminska-Ziemann B, Bloch-Bogusawska E.
Hangings in the material of Department of Forensic
Medicine, Nicolaus Coperni-cus University
Collegium Medicum in Bydgoszcz, in the years
20002010. Arch Med Sadowej Kryminol 2013 Oct
Dec;63(4): 26771.

13. Al Madni OM, Kharoshah MA, Zaki MK, Ghaleb SS.

Hanging deaths in Dammam, Kingdom of Saudi
Arabia. J Forensic Legal Med 2010 Jul;17(5):2658.
14. Uzun I, Buyuk Y, Gurpinar K. Suicidal hanging:
fatalities in Istanbul retrospective analysis of 761
autopsy cases. J Forensic Legal Med 2007
Oct;14(7):4069.
15. Suarez-Penaranda JM, Alvarez T, Miguens X,
Rodrguez-Calvo BL, de Abajo BL, Cortesao M, et
al. Characterization of lesions in hanging deaths. J
Forensic Sci 2008 May;53(3):7203.
16. Hejna P. Amussats sign in hanging a prospective
autopsy study. J Forensic Sci 2011 Jan;56(1):1325.
17. Nikolic S, Zivkovic V, Babic D, Jukovic F,
Atanasijevic T, PopovicV. Hyoid-laryngeal
fractures in hanging: where was the knot in the
noose? Med Sci Law 2011 Jan;51(1):215.
18. Charoonnate N, Narongchai P, Vongvaivet S.
Fractures of the hyoid bone and thyroid cartilage in
suicidal hanging. J Med Assoc Thai 2010
Oct;93(10):12116.
19. NikolicS, ZivkovicV. Cervical spine injuries in
suicidal hanging without a long-drop patterns and
possible underlying mecha-nisms of injury: an
autopsy study. Forensic Sci Med Pathol 2014
Jun;10(2):1937.

10

Terjemahan
Sebuah studi autopsi kematian karena
gantung diri
Abstrak Penelitian ini dilakukan
antara rahun 2010 dan 2013, dengan
total jumlah 7968 otopsi , terdapat
sebanyak 264 kasus akibat gantung
diri. Dan alat yang paling sering
digunakan adalah selendang (79) dan
sari (68). Dalam 88% kasus terjadi
gantung diri komplit. Dengan jumlah
korban 136 wanita dan 128 laki laki.
Sedangkan kelompok usia yang paling
banyak adalah rentang 31-40 tahun
dengan jumlah 136. Terdapat 213
insiden tanda ligature menunjukkan
diskontinuitas. Jenis simpul slip
adalah jenis simpul yang paling sering
digunakan dengan jumlah sebanyak
258. terlihat tanda pengikat berbentuk
miring sebanyak 232. Tanda vertikal
dan berbentuk miring terlihat hanya
dalam kasus suspensi parsial. Di
95.45% (252) dari kasus, tanda
pengikat menunjukkan kulit
menghitam (gesekan terbakar). Hanya
4,54% (12) menunjukkan kulit
utuh. Lapisan luar dari kulit di atas
tanda pengikat menunjukkan
perpindahan di sebagian besar kasus.
Korban menikah sebanayak 70,45%
kasus. Isu-isu domestik adalah alasan
paling umum (82) untuk gantung diri,
Mayoritas korban di dominasi oleh
perempuan (68). Di 70.83% (187) dari
kasus kerusakan serat otot leher dan
perdarahan pada akhir Sternal dari
sternokleidomastoid. Dalam 85,61%
(226) kasus vertebra serviks masih
utuh. Di 52,27% (138) dari kasus
internal arteri karotis menunjukkan air
mata melintang. Dalam 99,42% (248)
kasus kartilago tiroid ditemukan
utuh. Tulang hyoid rusak
6,06% (16). Sebagian besar korban,
59,09% (156) memiliki kelas ekonomi
sosial yang rendah.
1. Pendahuluan
Kematian akibat gantung ini
tidak biasa di seluruh dunia, ini
membuat mayoritas kematian
akibat asfiksia. Banyak
kecurigaan yang berhubungan
dengan cara kematian dalam
kasus gantung diri (lengkap
dan parsial) dan posisi tanda
pengikat, mengakibatkan
hukuman bagi yang tidak
bersalah atau rasa bersalah.
Oleh karena itu studi ini
dilakukan untuk studi secara
rinci temuan autopsi kematian
akibat gantung diri untuk
menghindari spekulasi ini
sekitar kematian gantung diri.
Studi ini membantu untuk
membedakan gantung diri dari
bentuk lain dari keadaan mayat
tergantung. Ini adalah sebuah
penelitian prospektif,
dilakukan antara tahun 2010
dan 2013. Dalam hal ini yang
dipelajari hanya temuan kasus
gantung diri untuk dianalisis
dan dipelajari secara
menyeluruh, cara kematian
yang lain dikesampingkan.
Semua informasi berkaitan
dengan keadaan ini
dikumpulkan dari polisi dan
dari anggota keluarga yang
meninggal. Semua faktor-
faktor yang dianggap penting
untuk menyimpulkan gantung
diri telah dianggap sebagai
unsur studi.
2. Bahan dan Metode
a. Sebanyak 7.968 Otopsi
dilakukan pada korban gantung
diri dengan presentase
3,31% (n - 264) kasus.
b. Semua kasus dirujuk ke
departemen hukum
kedokteram untuk otopsi dan
sebagai sumber bahan
di penelitian
c. Pemeriksaan TKP dilakukan
dalam beberapa kasus dan juga
terkait foto, data dan catatan.
d. Otopsi dilakukan dengan
penghapusan emmase dari
dada dan organ perut, leher
adalah organ terakhir yang
11
 dibedah setelah pengahpusan Kelompok usia yang lebih
struktur cranial sering untuk gantung diri
e. Silakukan penggambara, antara 21 dan 30 tahun,
pemotretan dan pembuatan memberikan kontribusi
sketsa untuk temuan tanda 31.06% (82) dari kasus.
ligatur eksternal Yang paling terkena
f. Untuk temuan internal pada dampak usia itu pada anak-
leher dilakukan diseksi lapis anak kurang dari 10 tahun
deni lapis di bagian leher (1). Terdapat insiden tidak
g. Pemeriksaan gross dan dilaporkan di atas 60 tahun
toluidine digunakan untuk (Tabel 3).
memeriksa kerusakan arteri 3.) Pada 80.58% (213) kasus
karotis ikatan menunjukkan
h. Fraktur serviks vertebra, tiroid, diskontinuitas (tidak
krikoid dan patah tulang hyoid lengkap) dan hanya
dikonfirmasi oleh pemeriksaan 19.32% (n-51)
radiologi dan selanjutnya menunjukkan tanda
dikonfirmasi melalui metode pengikat lengkap
diseksi. (Continuity). Bentuk
i. Pengikat selalu dibawa miring dari tanda pengikat
bersama dengan mayat dengan terdapat 7.88% (232) dari
simpul dan simpul utuh. kasus. 6.82% (18) kasus
menunjukkan tanda
3. Hasil pengikat horisontal i dan
1.) Bahan-bahan pengikat 5,30% (14) dari kasus
yang paling umum menjadi menunjukkan tanda
pilihan yaitu selendang pengikat miring. Tanda
(79; 29.92%) dan Sari (68; pengikat horizontal dan
25.76%). Yang paling miring terlihat hanya dalam
umum bahan pengikat kasus menggantung parsial.
pilihan adalah ikat Di 94.31% dari kasus tanda
pinggang (2; 0,76%). pengikat (249) ditandai
Bahan lain yang digunakan oleh pengelupasan (abrasi),
adalah tali plastik (28; berlekuk, konsistensi kasar,
10.68%), sprei tempat tidur pucat dan menunjukkan
(22; 8,33%) dan tali katun penumpukan dan
(19; 7,20%) di urutan penglupasan permukaan
terbawah. Mayoritas dari kulit di sekitar bekas
jenis simpul slip pengikatan. Di 82.58%
berkontribusi 97.73% (n- (218) dari kasus tanda
258) dari gantung diri dan pengikat berada di atas
hanya 2,27% (6) tulang rawan tiroid. Hanya
menunjukkan simpul tetap 7,20% berada di bawah
(Tabel 2). tulang rawan tiroid,
2.) Jumlah korban gantung diri sedangkan 10,22% (27)
perempuan (136) dan laki- yang terletak di atas tulang
laki (128) hampir sama. rawan tiroid. 95.45% (252)
Kelompok usia utama tanda pengikat
terpengaruh kedua jenis menunjukkan kulit
kelamin adalah dalam menghitam (gesekan
kisaran 31-40, terbakar). Hanya 4.54% (n-
berkontribusi 50.76% (136) 12) menunjukkan kulit
dari kasus gantung diri. utuh. Pengelupasan epitel
12
 adalah searah, 162 kasus
menunjukkan pergeresan
arah kanan dan 84 kasus
menunjukkan pergeseran
ke kiri, dan 18
menunjukkan ada tanda-
tanda perpindahan jaringan
epitel (Tabel 4).
4.) Dari total 264 kasus
gantung diri, 88% dari
menggantung lengkap dan
12% karena menggantung
parsial. Sebagian besar
korban, 59.09% (156)
orang miskin atau kelas
sosial ekonomi rendah, dan
34.09% (90) pada kelas
rata-rata. Hanya 6.82%
(18) dari golongan
penghasilan tinggi. Di
91.67% (n-242) kasus,
insiden terjadi di dalam
rumah, dan tempat yang
paling sedikit di tempat
kerja di 2,27% (06). Dan
tempat pilihan lainnya
berada di luar rumah di
9,85% (26). Mayoritas
korban menikah terdiri dari
70.45% dari kasus dan
hanya 29.55% dari kasus
yang belum menikah
(Tabel 5).
5.) Isu-isu domestik adalah
faktor yang paling umum
yang bertanggung jawab
(82) untuk gantung diri,
wanita (68) dibentuk
berbagi besar korban. Hal
ini diikuti oleh hubungan
percintaan (n-64), sebagian
besar korban adalah
perempuan (49). Penyebab
lain adalah dampak dari
penyakit (54) korban
menarik untuk gantung
diri. Faktor-faktor lain
seperti masalah keuangan
(38), masalah pendidikan
karir (18) dan masalah
pekerjaan (10)
berkontribusi terhadap
gantung diri.
13
6.) 70.83% (187) kasus
menunjukkan memar,
kerusakan serat otot dan
perdarahan pada akhir otot
Sternokleidomastoid.
85.61% (226) kasus
menunjukkan tulang leher
utuh, hanya 14.39% (38)
menunjukkan fraktur
melibatkan tulang leher.
52.27% (138) kasus
menunjukkan robekan
melintang arteri karotid.
99.42% (248) kasus
menunjukkan rawan tiroid
utuh, hanya 0,76% (2)
menunjukkan kerusakan
tulang rawan tiroid,
demikian pula pada
93.94% (248) kasus adalah
tulang hyoid utuh. Tulang
hyoid rusak dalam 6.06%
(16) para korban. Tidak
ada korban menunjukkan
kerusakan krikoid tulang
rawan dalam kasus gantung
diri .
4. Diskusi
Penelitian prospektif ini dilakukan
antara 2010 dan 2013. Total 7968
kasus otopsi kematian yang
dikarenakan gantung diri 3.31% (n-
264) dari otopsi. Studi serupa yang
dilakukan oleh Hassan et al. dalam
waktu dua tahun di Kuwait
melaporkan total 118 kasus. Dalam
studi lain yang dilakukan oleh Kumar
dan Verma di Lucknow (India) total
dari 4405 kasus yang otopsi dalam
periode lima tahun yang hanya 10%
kasus adalah karena gantung diri.
Dean et al. telah belajar pada kasus-
kasus 229. Maka sosial ekonomi dan
budaya faktor regional memainkan
peran penting dalam gantung diri.
Oleh karena itu Penelitian ini unik
karena jumlah tertinggi studi kasus
dibandingkan dengan studi lain di
tempat lain di dunia. Penelitian ini
dibandingkan dengan studi lain yang
dilakukan di tempat lain dalam
kaitannya dengan berbagai insiden
sekitarnya di Tabel 6 bunuh diri.
Dalam penelitian ini mungkin pilihan
bahan pengikat yang digunakan adalah
gaun wanita (lembut), selendang (79)
dan Sari (68) dan jumlahnya 55.68%
(147) kasus dan pilihan yang paling
tidak disukai adalah ikat pinggang,
dilaporkan dalam studi tersebut hanya
2 kasus (0,76%), pengamatan yang
dilakukan oleh Jayprakash dan
Sreekumar Sharma et al. , mereka
telah berpendapat 47% dan 56% dari
korban mereka masing-masing pilihan
bahan pengikat lembut seperti sari,
syal, selendang. Hasil ini adalah
bertentangan dengan pengamatan yang
dilakuan oleh Pradhan et al. dimana
mereka telah mengamati bahwa hanya
9,09% (4) menggunakan sari.
Sedangkan studi yang dilakukan oleh
Saisudheer dan Nagaraja
menyimpulkan dengan 86% dari
bahan yang lembut digunakan untuk
pengikat. Dengan bahan pengikat
14
keras seperti tali plastik, tali sabut dan
tali katun terdapat 22.72%,
pengamatan serupa dilakukan oleh
Jayprakash dan Sreekumar. Hal ini
terjadi berbagai penyimpangan dalam
pilihan bahan pengikat tergantung
pada mode pakaian masyarakat. Hal
ini menunjukkan bahwa Sari di bagian
Selatan India dan selendang antara
perempuan dari India Utara secara
luas digunakan dan tersedia dengan
mudah di rumah dan karenanya
pilihan yang jelas di daerah ini.
Sedangkan di Inggris (Bennewith) 10
pilihan paling umum adalah bahan-
bahan keras seperti Tali, sabuk, kabel
dan kabel, bahan-bahan yang lembut
seperti Sari atau selendang tidak
ditemukan di wilayah itu. Karena
faktor-faktor seperti jenis kelamin
korban, budaya, lokasi geografis dan
tempat bermain tindakan peran
penting dalam hal ini.
Egyptian Journal of Forensic Sciences (2016) 6, 4855

HOSTED BY Contents lists available at ScienceDirect

Egyptian Journal of Forensic Sciences

journal homepage: http://www.journals.elsevier.com/egyptian-journal-of-forensic-sciences

ORIGINAL ARTICLE

Sex identification and reconstruction of length of

humerus from its fragments: An Egyptian study

Dalia Mohamed Ali a,*, Fatma Alzhraa Fouad Abd Elbaky b

a b
Forensic Medicine & Toxicology Department, Faculty of Medicine, Minia University, Egypt
Anatomy Department, Faculty of Medicine, Minia University, Egypt

Received 16 November 2015; revised 22 February 2016; accepted 21 March 2016

Available online 11 April 2016

KEYWORDS
Abstract: The aim of this study was to calculate the total length of the humerus and identify the sex from
Sex estimation; its fragments in Egyptians. One hundred and fifty dry adult right humeri (75 male and 75 female) were
Length; studied. The humeri were divided into seven fragments according to specific anatomical landmarks. Data
Humerus; obtained was subjected to descriptive statistical analysis. The longest fragmentary portion revealed a
Fragments; good result with closest proximity to the total length of humerus. All fragments showed significant
Egyptian sexual differences (P < 0.001) between males and females except H2. Total length of humerus revealed
the highest percentage of accuracy (93.3%) followed by H4 (86.7%) and H7 (83.3%) for sex
identification. Finally, from measurements of different humeral fragments in Egyptian population; the
length of the humerus can be estimated and the sex can be identified.
2016 The International Association of Law and Forensic Sciences (IALFS). Production and hosting by Elsevier
B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-
nc-nd/4.0/).

15
1. Introduction

Several factors are essential for forensic experts to be able to identify an unknown dead body in many anthropological cases and
traumatic events. Identifying the sex of a body and esti-mating the bodys stature are considered the most important factors in
1
establishing the identity of indefinite dead bodies, parts of bodies, or even skeletal fragments.
In forensic examinations, sex determination is considered the simplest assignment because the external and internal gen-italia can
2
directly assert the sex of the deceased. On the other hand, in cases of severely decomposed, commingled, and dis-membered dead
bodies, determining the sex of the deceased

is a challenging task. In addition, sex determination is impor-tant to evaluate other parameters of a biological profile, such as stature and
3
age.
There are many techniques to determine the demographics (e.g., sex and race) from skeletal remains in the field of forensic
anthropology. A qualitative morphological examination (non-metrical method) is the simplest and fastest method with 95100%
accuracy if the whole skeleton is available and the observer is an expert. This method depends on visual inspec-tion of the sexual and
4
physical characteristics of the bones, which are distinctive to the elements of the human skeleton.
A second technique, a morphometric method, relies on measurements and statistical techniques. These methods are considered more
5
advantageous for data evaluation and its application to the skeleton. However, many indices depend on direct distances between two
6,7
bony landmarks, and the com-plicated pattern of an osseous curve cannot be studied.
Later, a combination of morphometric and meristic charac-teristics is used as a new technique. Geometric morphometrics is a method
that can compute the differences of the shape of bones in a two- or three-dimensional (2D or 3D) coordinate system by obtaining the
8 9,10
mean. Recent advances in geometric morphometrics allow analyses of bone configurations and sex determination.
It was difficult to estimate a bodys stature from available bone fragments following mass disasters or even from archeo-logical
remains. Some forensic experts neglected fragments of bones, thinking that no benefit could be gained from such frag-ments; however, in
11
1935, Muller recorded a scientific basis for estimating long bone length from fragments.
1
It has been reported that the stature of an individual can be estimated from the length of the long bones of the limbs. The femur was
12,13
considered the most ideal bone to estimate stature in the majority of past studies. However, populations dif-fer in the relationship
14
between stature and lengths of limb bones. Therefore, specific equations for stature estimation are required for each population.
1517 18,19 20,21
Many researchers studied the sexual dimorphism of adult skeletons using the dimensions of the skull, face , long bones ,
2224 25,26
hands, feet , and pelvis. Scholars proved
27
that a specific study is needed for each population to gain accu-rate results for the sexual identification of a skeleton. Dis-
28,29
criminant function analysis had been used to estimate the sex from bones if they are suspected to be sexually dimorphic.
30
The pelvis was considered to be the most accurate bone for sex determination, as it allows for parturition in females.
The humerus is one of the important long bones of the skeleton due to its strength, even in a fragmented state, and it is possible to be
recovered in a forensic case. Classical osteo-metric techniques have been used to realize the value of esti-mating the humerus length
31,32 33,34
from its fragments and confirming the existence of sexual dimorphism in the humerus. In anthropometric studies, the humerus
is a moderately studied bone. It plays an essential role in sex iden-
35
tification, stature estimation of the individual, forensic studies, etc.
The aim of this study was to derive regression equations for establishing the total length of the humerus and discriminant function
equations for sexual identification using different humerus fragmentary measurements in Egyptian populations.

2. Materials and methods

The humerus bone collection used in this study was obtained from the dissected cadavers of Egyptians in the Forensic Med-icine
Department of the Justice Office in Minia Governates-Egypt and also from the Anatomy Department of Minia and Cairo universities.
These bones were selected in a dried and fully ossified state. The deformed, atrophied, or pathological bones were not included in this
study. The age and sex of the cadavers were recorded; however, full information about the individuals was unavailable.
By a simple random sampling technique, 150 humeri (75 males, 75 females) of an Egyptian population were chosen. The age for both
sexes at death ranged between 20 and 60 years. The period of human history from which the bones have been collected is not recorded in
the archives of the anat-omy department of Minia and Cairo Universities. The right humeri only were used in this study because both
humeri of the same individual were unavailable and the right side was the dominant side.
Eight measurements were taken from each humerus. Each humerus was fragmented by drawing imaginary lines at differ-ent
anatomical landmarks (Fig. 1).
The anatomical landmarks are:

a: is the most proximal point on the head

b: is the most inferior point on the margin of the articular surface on the head
c: is at the convergence of two areas of muscle attachment just below the major tubercle

16
 d: is at the upper margin of the olecranon fossa
e: is at the lower margin of the olecranon fossa
f: is at the most distal point on the trochlea
g: is the most lateral protruding point on the lateral epicondyle
h: is the most medial protruding point on the medial epicondyle
i: is the most superior point on the margin of the articular surface of the head

50 D.M. Ali, F.A.F. Abd Elbaky

The total length of each humerus was measured roughly using

a metal ruler, but other measurements were taken by a digital
caliper. The digital caliper provides precision readings from 0.01
mm and 0.000500 through a clear liquidcrystal dis-play (Fig. 2).

3. Statistical analysis

The data obtained were analyzed using statistical package, SPSS,

version 20.0. Mean and standard deviation were calcu-lated for all
measurements.
Figure 2 H7 (The vertical head diameter).
3.1. Length of humerus
The measurements are modifications of previous osteologi-cal
36,37 A regression formula is the most accepted method in determin-ing
studies.
38
The measurements include: a bodys stature from various anthropometric dimen-sions. In
this study, a simple linear regression analysis was done to derive
H1(af): is the total length of humerus, H2 (ab), H3 (bc), H4 regression equations for estimating the total length of a humerus
(cd), H5 (de), H6 (ef), H7 (ib) is the vertical head from its fragments. The significant param-eters, such as t-ratio, P-
diameter and H8 (gh) is the biepicondylar width. value, and correlation coefficient, were

17
Table 1 Descriptive statistics for humerus measurements, Corr-coef (r), and P-value irrespective of sex.
Total number 150 Mean SD Proportion in % Corr-coef (r) P-value
H1 31.37 1.33 100 0
H2 3.14 0.3 10.02 0.98 0.166 0.042
H3 1.98 0.29 6.31 0.78 0.637 <0.001
H4 22.65 0.95 72.2 1.4 0.895 <0.001
H5 1.91 0.23 6.07 0.61 0.590 <0.001
H6 1.68 0.17 5.37 0.46 0.603 <0.001
H7 4.28 0.36 13.63 0.95 0.568 <0.001
H8 5.9 0.31 18.84 1.01 0.405 <0.001

H1(af): is the total length of humerus, H2 (ab), H3 (bc), H4 (cd), H5 (de), H6 (ef), H7 (ib) is the vertical head diameter and H8 (gh) is the
biepicondylar width.

Table 2 Morphometric humerus measurements among males and females in Egyptian population.
Fragment Male/female Mean SD Proportion to the total length (%)
H1 Male 32.42 0.81 100 0
Female 30.32 0.81 100 0
H2 Male 3.15 0.24 9.73 0.83
Female 3.13 0.35 10.32 1.04
H3 Male 2.12 0.28 6.54 0.77
Female 1.84 0.22 6.08 0.73
H4 Male 23.31 0.72 71.89 1.29
Female 21.98 0.63 72.51 1.44
H5 Male 2.05 0.18 6.33 0.58
Female 1.76 0.17 5.82 0.53
H6 Male 1.78 0.16 5.48 0.47
Female 1.59 0.13 5.25 0.42
H7 Male 4.46 0.32 13.77 0.96
Female 4.09 0.3 13.49 0.94
H8 Male 6.07 0.16 18.73 0.64
Female 5.74 0.33 18.94 1.27

H1(a-f): is the total length of humerus, H2 (a-b), H3 (b-c), H4 (c-d), H5 (d-e), H6 (e-f), H7 (i-b) is the vertical head diameter and H8 (g-h) is the
biepicondylar width.
Sex identification and reconstruction of length of humerus
given while calculating the length of a humerus to correlate the
different fragments to the total humerus length.
3.2. Sex estimation
A Students t-test was performed to establish the significant
differences between male and female measurements. A univari-
ate discriminant function analysis was performed for signifi-cant
measurements to test its efficiency in sex estimation. Coefficients
and constants were obtained for calculating dis-criminant function
scores and equations. In addition, demark-ing points, which are
the average of male and female mean values, were obtained.
All the statistical calculations and comparisons have been
carried out at a 5% level of significance (i.e., P = 0.05).
51
1.33 cm; correlation coefficients for all humerus measure-ments
versus total lengths (H1) were significant (P < 0.05) (Table 1).
Mean values for males and females and proportions of the
measurements to total length of humeri are presented in Table 2.
The longest fragment (H4) revealed the closest prox-imity to the
total length of the humerus in both sexes (males 71.89 1.29%
[23.31 0.72 cm] and females 72.51
1.44% [21.98 0.63 cm]) (Table 2).
Table 3 provides a correlation coefficient (r), t-ratio, P-
value, and regression equations for all measurements of males and
females. The humerus fragments showed significant posi-tive
correlations with the total length of humeri (P < 0.05); however,
the H3 and H8 fragments in females and the H2, H5, and H8
fragments in males were insignificant (P > 0.05).

4. Results

This study examined 150 humerus bones (75 male and 75

female). Eight measurements were taken from each humerus.
Irrespective of sex, the total length of a humerus was 31.37

18
 of males and females (P < 0.001) (except the H2 fragment where
there was an insignificant difference, P > 0.05), which indicates
Table 4 Significant statistical variables for humerus lengths
differences among males and females. the presence of sexual dimorphism in the measure-ments of
humerus fragments for the Egyptian population (Table 4).
Fragment Wilk lambda P value
H1 0.375 <0.001 Discriminant function statistics that estimated the sex of
H2 0.999 0.686 unknown humerus fragments are presented in Table 5. Sex can be
H3 0.772 <0.001 estimated from humerus fragments by calculating a dis-criminant
H4 0.511 <0.001 score ([measurement coefficient] + constant). The sectioning point
H5 0.616 <0.001
for all functions is zero; if the score is P0, it is considered male;
H6 0.720 <0.001
however, if the score is <0, it is considered female.
H7 0.740 <0.001
H8 0.711 <0.001
The most effective measurement for sex estimation by uni-
H1(af): is the total length of humerus, H2 (ab), H3 (bc), H4 (c d), variate discriminant analysis was the H1 fragment (the total
H5 (de), H6 (ef), H7 (ib) is the vertical head diameter and H8 (g length of a humerus), which had the highest percentage of
h) is the biepicondylar width.
accuracy (93.3%). This was followed by the H4 fragment (86.7%
accuracy), H7 fragment (vertical head diameter, 83.3%), H8
fragment (biepicondylar width, 76.7%), H5
By Students t-test, all measurements of the humerus frag-
ments revealed significant differences between the mean values

Table 3 Simple linear regression statistics for reconstruction of humerus length from its fragments.
Fragment Sex Corr-coef (r) T ratio P value Regression equation Y = a + bX

H2 M 0.211 1.84 0.07 H1 = 34.66 + ( 0.708H2)

F 0.538 5.45 <0.001 H1 = 26.4 + (1.25H2)
H3 M 0.707 8.53 <0.001 H1 = 28.15 + (2.009H3)
F 0.204 1.78 0.078 H1 = 28.55 + (0.741H3)
H4 M 0.816 12.04 <0.001 H1 = 11.02 + (0.918H4)
F 0.746 9.57 <0.001 H1 = 9.12 + (0.964H4)
H5 M 0.021 0.18 0.855 H1 = 32.23 + (0.094H5)
F 0.407 3.81 <0.001 H1 = 27.03 + (1.866H5)
H6 M 0.418 3.93 <0.001 H1 = 28.73 + (2.074H6)
F 0.283 2.51 0.014 H1 = 27.59 + (1.718H6)
H7 M 0.269 2.38 0.02 H1 = 29.41 + (0.676H7)
F 0.361 3.31 0.001 H1 = 26.39 + (0.960H7)
H8 M 0.122 1.05 0.295 H1 = 28.67 + (0.618H8)
F 0.120 1.03 0.306 H1 = 32.01 + ( 0.293H8)
H1(af): is the total length of humerus, H2 (ab), H3 (bc), H4 (cd), H5 (de), H6 (ef), H7 (ib) is the vertical head diameter and H8 (gh) is the
biepicondylar width.

19
52 D.M. Ali, F.A.F. Abd Elbaky

Table 5 Univariate discriminant function analysis with demarking points for sex identification of humerus in Egyptians.
Fragment Constant Coecient Sectioning point Accuracy (%) Demarking point
In males In females Total

H1 38.288 1.22 0 93.3 93.3 93.3 Male > 31.37 > female
H3 7.668 3.86 0 60 66.7 63.3 Male > 1.98 > female
H4 33.179 1.465 0 80 93.3 86.7 Male > 22.645 > female
H5 10.44 5.466 0 66.7 80 73.3 Male > 1.905 > female
H6 11.183 6.63 0 73.3 66.7 70 Male > 1.685 > female
H7 13.483 3.15 0 80 86.7 83.3 Male > 5.275 > female
H8 22.47 3.804 0 80 73 76.7 Male > 5.905 > female
H1(af): is the total length of humerus, H2 (ab), H3 (bc), H4 (cd), H5 (de), H6 (ef), H7 (ib) is the vertical head diameter and H8 (gh) is the
biepicondylar width.

fragment (73.3%), H6 fragment (70%), and H3 fragment (63.3%) 14

(Table 5).
Table 5 also presents the demarking points, which are the
sums of the mean values for males and females divided by 2. If
the measured value was greater than the demarking point, it was
assigned as a male, while lesser values suggested a female.
Note: All measurements are in centimeters.
5. Discussion
The measurements of the length of long bones are essential tools
for estimating an individuals stature. These estimations play an
important role for medico-legal investigations in iden-tifying
39
missing persons. Because the humerus is the longest, largest,
and strongest (even in a fragmented state) bone of the upper body,
stature estimation can be done from a humerus in the absence of
other proper long bones, such as a femur. Hence, it is essential to
32
identify the humeral length from its fragmental measurements.
The importance of the total humerus length in identifying specific
features of a popu-lation has been reported.
40
Regression analysis is better suited for estimating the rela-
tionship among variables: between the height of the individuals
and the length of the long bones and between maximum length of
41
the long bones and the measurements of their fragments. It has
been suggested that each population has specific regres-sion
equations that should not be applied to other populations, as this
42
may lead to underestimation or overestimation of stature.
43
Mysorekar et al. reported significant differences in humerus
lengths between the right and left sides and computed different
equations for each side. In the present study, we for-mulated a
regression equation for each humeral fragment, with the sex
identified on the right side in an Egyptian population. This was to
estimate the total length of a humerus to obtain accurate results.
In this study, our results revealed that the mean humeral
length on the right side, irrespective of sex, was 31.37
1.33 cm. This result agrees with a study done by Salles
44
et al. in Brazil; the mean humeral length was 31.3
2.3 cm. A study was conducted in southern India, reveal-ing
32 45
that the mean humeral length was 30.28 2.44 cm. Devi et al.
found that there is a significant difference between the right and
left sides in some humeral measure-ments; in their study, the
mean humeral length was 30.84
1.78 cm on the right side. A study by Mahakkanukrauh et al.
was carried out on a sample from a northern Thai population and
found that the mean humeral length was 30.78 1.57 cm. All
previous studies revealed that the mean humeral length ranges
between 30 and 31 cm with standard deviation.
All humerus fragments, irrespective of sex, showed a posi-tive
correlation with the total length of the humerus. This result agrees
36
with a study carried out by Mohanty et al. in which all
fragments (coinciding with our studys H2, H3, H4, H5, and H6
fragments) revealed a positive correlation to total humeral length.
46
A study by Gayatri el al. revealed a sig-nificant vertical
diameter of the humerus head and a biepi-condylar width of the
distal end of the humerus to the total humeral length. Premchand
47
and Manjappa revealed signifi-cant humeral segments that
coincide with the H2, H5, and H6 segments in our study. Udhaya
et al.
32
showed significant biepicondylar width and vertical
diameter of the superior artic-ular surface with significant
maximum humerus length of up to 78% of contribution.
On sex differentiation, our study revealed that the mean
humeral length on the right side was 32.42 0.81 cm for males
and 30.32 0.81 cm for females. Our results are almost similar to
other studies, as in a south Indian population; the mean humeral
length was 31.78 0.3 cm for males and 30.14 0.45 cm for
36 1
females. Mall et al. conducted a study at the Anatomical
Institutes in Munich and Cologne, revealing that the mean
maximum humeral length was 33.4 cm for males and 30.7 cm for
48
females. Holman and Bennett obtained sam-ples from white
North American individuals and found that the humeral length
was 32.6 cm in males and 30.0 cm in females.
These minimal variations in lengths may be due to the dif-
ferences between populations as a result of environmental fac-
tors, genetic factors, nutrition, and different lifestyles that affect
49
bone growth and development.
In the present study, the fourth fragment, H4, showed very
good results and was very close to the total length of the humerus,
either sex aggregated or sex differentiated. It is clear from our
study that longer segments of bone are better for esti-mating the
total lengths of humeri rather than shorter seg-ments within
36
subpopulations. This result is similar to that of Mohanty et al. ,
as the longest segment (H4) constitutes 67.06% (21.33 cm) by
proportion to the total length of the humerus in males; in females,
it constitutes 66.3% (19.98 cm) of the total length.

20
Sex identification and reconstruction of length of humerus
The humerus fragments in this study showed significant
positive correlations with the total humerus length; the H3 and H8
fragments in females and the H2, H5, and H8 frag-ments in male
36
were insignificant. On the other hand, Mohanty et al. revealed
that in males, all humerus fragments were sig-nificant except the
H2 fragment, but in females, all humerus fragments were
significant for estimating the total length of the humerus. Mall et
1 sexual dimorphism may be due to the
al. showed significant vertical head diameters and epicondylar
widths of humeri. There are no sim-ilar studies available for
Egyptian populations that can be used to compare with our study.
Sex determination is the first step in identifying and individ-
ualizing an unknown person in forensic sciences. The discrim-
inant function equations for sex identification of skeletal remains
are considered a common practice; however, it has been reported
that these functions are likely to be population specific, so it is
50
essential for every region to develop its own equation.
In our study, for all male and female humerus samples, the
results revealed that there was a significant difference between
males and females in all measurements except for the H2 frag-
ment. This indicates the presence of sexual dimorphism in the
measurements of humerus fragments for the Egyptian popula-
tion. Therefore, the discriminant function results in this study will
be significant tools for investigators in forensic science.
A univariate discriminant function analysis was performed for
significant measurements to test its efficiency in sex estima-tion.
The total length of the humerus (H1) revealed the highest
percentage of accuracy (93.3%) followed by the H4 fragment
(86.7%), H7 (vertical head diameter, 83.3%), H8 (biepicondy-lar
width, 76.7%), H5 (73.3%), H6 (70%), and H3 (63.3%).
Therefore, the length of the humerus was the most sexually
dimorphic for the Egyptian population.
Our results agree with a study carried out by Singh and
51
Singh in an Indian population and found that the maximum
length of the humerus is a good measurement for identifying the
sex of an individual. Also, a study performed in southern India by
52
Patil et al. revealed that the two measurements with the greatest
sex differences were the maximum humeral length and the
maximum diameter at midshaft.
1
Our results are in contrast with those obtained by Mall et al. ,
revealing that the head diameter of the humerus is the most useful
dimension for discriminating sex. The epi-condylar width was the
third best of all measurements and bet-ter for identifying sex than
the maximum length of the humerus.
53
Also, a comparative study done by Iscan et al. showed that
the most accurate measurement was the humeral epi-condylar
width, with an accuracy of 90% in a Japanese popu-lation and
93% in a Thai population; the vertical humeral head diameter was
the most accurate measurement (81%) in a Chinese population.
17
Frutos revealed that the vertical head diameter and epicondylar
breadth of the humerus on the left side were significantly greater
in males than females, with a percentage of accuracy of 95.5%,
91.1%, and 83% for the maximum diameter of the head,
epicondylar breadth, and maximum length of the humerus,
54
respectively. Soni et al. found that the single best parameter for
sexual dimorphism was epicondylar width (87.5%). Other authors
suggested that the most effective measurements for sexual
55
dimorphism was the vertical head diameter.
21
53
Sexual dimorphism in the humeral measurements may be due
to differences in body size, muscular activity, discrepancy in bone
remodeling between the sexes, and greater develop-ment of
56
cortical bone during adolescence in males than in females.
Some authors suggested that the differences in the sexes and
statures among different populations may be due to extremely low
57
or extremely high protein consumption. Others showed that
effect of physical activity on bones that influence the diaphy-seal
58,59
dimensions of the long bones.
7. Conclusions
Our study has shown that the humerus is a useful bone, even in a
fragmented state, for identifying sex and estimating humeral
length. Identifying commingled and dismembered remains, such
as in cases of explosions, air disasters, natural disasters,
mutilations, or in certain cases of homicide, can be helpful to
estimate the stature and distinguish the sex of an individual with
the highest percentage of accuracy using the total length of
humerus (93.3%).
Hence, our study is helpful to forensic and anthropometric
investigations in identifying the remains of unknown dead bodies
in Egypt. Because of the unavailability of the stature of the
individuals included in this study, it was difficult to test the
exactness of the results with the bone fragments. Therefore,
further studies are required when more information about the
individuals is available, and both humerus bones, right and left
are required.
Funding
None.
Conflict of interest
There is no conflict of interest between any of the authors.
Ethical approval
The study was approved by the University ethics committee.
References
1. Mall G, Hubig M, Butter A, Kuznik J, Penning R, Graw M. Sex
determination and estimation of stature from the long bones of the
arm. Forensic Sci Int 2001;117:2330.
2. Kanchan T, Krishan K. Anthropometry of hand in sex determi-nation
of dismembered remains a review of literature. J Forensic Leg Med
2011;18:147.
3. Hemy N, Flavel A, Ishak NI, Franklin D. Sex estimation using
anthropometry of feet and footprints in a Western Australian
population. Forensic Sci Int 2013;231, 402.e1-6.
4. Introna FJ, Di Vella G, Campobasso CP, Dragone M. Sex
determination by discriminant analysis of calcanei measurements.
J Forensic Sci 1997;42:7258.
5. Walrath DE, Turner P, Bruzek J. Reliability test of the visual
assessment of cranial traits for sex determination. Am J Phys
Anthropol 2004;125:1327.
6. Vacca E, Di Vella G. Metric characterization of the human coxal
bone on a recent Italian sample and multivariate discriminant analysis
to determine sex. Forensic Sci Int 2012;222, 401.e1-9.
54
7.
3. Kanabur V. Identification of the sex of human hip bone by metric
analysis of its anterior border. Biomed Res 2012;23:2114.
4. Adams DC, Rohlf FJ, Slice DE. Geometric morphometrics: ten years
of progress following the revolution. Ital J Zool 2004;71:516.
5. Gomez-Valdes JA, Quinto-Sanchez M, Garmendia AM, Vele-minska
J, Sanchez- Mejorada G, Bruzek J. Comparison of methods to
determine sex by evaluating the greater sciatic notch: visual, angular
and geometric morphometrics. Forensic Sci Int 2012;221(156):e17.
6. Veleminska J, Krajicek V, Dupej J, Gomez-Valdes JA, Veleminsky
A, Sefcakova A, et al. Technical note: geometric morphometrics and
sexual dimorphism of the greater sciatic notch in adults from two
skeletal collections: the accuracy and reliability of sex classification.
Am J Phys Anthropol 2013;152:55865.
7. Muller G. Zur Bestimmung der Lange beschadigter Extremitaten-
knochen. Anthropol Anz 1935;12:702.
8. Wilson RJ, Herrmann NP, Meadows JL. Evaluation of stature
estimation from the database for forensic anthropology. J Forensic Sci
2010;55:6849.
9. Nath S, Badkur P. Reconstruction of stature from long bone lengths.
In: Bahsin MK, Malik SL, editors. Anthropology: trends and
applications. Delhi, India: Kamla-Raj Enterprises; 2002. p. 10914.
10. Mahakkanukrauh P, Khanpetch P, Prasitwattanseree S, Vichairat
Case D, Troy Case D. Stature estimation from long bone lengths in a
Thai population. Forensic Sci Int 2011;210, 279.e1-7.
11. Steyn M, Iscan MY. Osteometric variation in the humerus: sexual
dimorphism in South Africans. Forensic Sci Int 1999;106:7785.
12. Sakaue K. Sexual determination of long bones in recent Japanese.
Anthropol Sci 2004;112:7581.
13. Frutos R. Metric determination of sex from the humerus in a
Guatemalan forensic sample. Forensic Sci Int 2005;147:1537.
14. Nidugala H, Bhargavi C, Avadhani R, Bhaskar B. Sexual dimorphism
of the craniofacial region in a South Indian popula-tion. Singapore
Med J 2013;54:45862.
15. Akhlaghi M, Khalighi Z, Vasigh S, Yousefinejad V. Sex determi-
nation using mandibular anthropometric parameters in subadult
Iranian samples. J Forensic Leg Med 2014;22:1503.
16. Albanese J. A method for estimating sex using the clavicle, humerus,
radius, and ulna. J Forensic Sci 2013;58:14139.
17. Akhlaghi M, Sheikhazadi A, Ebrahimnia A, Hedayati M, Naz-parvar
B, Saberi Anary SH. The value of radius bone in prediction of sex
and height in the Iranian population. J Forensic Leg Med
2012;19:21922.
18. Krishan K, Kanchan T, Asha N, Kaur S, Chatterjee PM, Singh B.
Estimation of sex from index and ring finger in a North Indian
population. J Forensic Leg Med 2013;20:4719.
19. Barrett CK, Case DT. Use of 2D:4D digit ratios to determine sex. J
Forensic Sci 2014;59:131520.
20. Krishan K, Kanchan T, Passi N, DiMaggio JA. Sexual dimor-phism
in foot length ratios among North Indian adolescents. J Forensic Leg
Med 2015;36:96101.
21. Hayashizaki Y, Usui A, Hosokai Y, Sakai J, Funayama M. Sex
determination of the pelvis using Fourier analysis of postmortem CT
images. Forensic Sci Int 2015;246, 122.e1-9.
22. Karakas HM, Harma A, Alicioglu B. The subpubic angle in sex
determination: anthropometric measurements and analyses on
Anatolian Caucasians using multidetector computed tomography
datasets. J Forensic Leg Med 2013;20:10049.
23. Kranioti EF, Bastir M, Sanchez-Meseguer A, Rosas A. A geometric-
morphometric study of the cretan humerus for sex identification.
Forensic Sci Int 2009;189, 111.e1-8.
24. Kanchan T, Krishan K, Sharma A, Menezes RG. A study of
correlation of hand & foot dimensions for personal identification in
mass disaster. Forensic Sci Int 2010;199, 112.e1-6.
25. Russo EG. Sex determination from the talus and calcaneus
measurement. Forensic Sci Int 2007;171:1516.
22
D.M. Ali, F.A.F. Abd Elbaky
2 Lundy JK. Forensic anthropology: what bones can tell us. Lab Med
1998;29:4237.
3 Chandra NS, Nath S. Estimation of humeral length from a single
fragmentary bone measure. J Indian Acad Forensic Sci 1984;23:114.
4 Udhaya K, Sarala DKV, Sridhar J. Regression equation for estimation
of length of humerus from its segments: a south Indian population
study. J Clin Diagn Res 2011;5:7836.
5 Albanese J, Cardoso HFV, Saunders SR. Universal methodology for
developing univariate sample-specific sex determination meth-ods: an
example using the epicondylar breadth of the humerus. J Arch Sci
2005;32:14352.
6 Steyn M, Iscan MY. Osteometric variation in the humerus: sexual
dimorphism in South Africans. Forensic Sci Int 1999;106:7785.
7 Prateek G, Shalini G, Anupama M, Chakravarthi KK. Estimation of
height using length of humerus in adult North Indian populationan
anthropometric study. Int J Sci Res 2012;2:13.
8 Mohanty S, Sahu G, Das S. Estimation of length of humerus from its
fragmentary portions. J Forensic Leg Med 2012;19:31620.
9 Singhal S, Rao V. Estimation of total length of humerus from its
segments. Med Sci Law 2011;51:1820.
10 Iscan MY. Forensic Anthropology of sex and body size. Forensic Sci
Int 2005;147:10712.
11 Ross AH, Konigsberg LW. New formulae for estimating stature in the
Balkans. J Forensic Sci 2002;47:1657.
12 Wright LE, Vasquez MA. Estimation of the length of incomplete
long bones: forensic standards from Guatemala. Am J Phys Anthropol
2003;120:23351.
13 Krishan K. Anthropometry in forensic medicine and forensic science-
Forensic Anthropometry. Internet J Forensic Sci 2007;2(1).
14 Zverev Y, Chisi J. Estimating height from the arm span measure-ment
in Malawian children. Coll Antropol 2005;29:46973.
15 Mysorekar VR, Nandedkar AN, Sarma TC. Estimation of stature
from parts of humerus and radius. Med Sci Law 1982;22:17880.
16 Salles AD, Carvalho CRF, Silva DM, Santana LA. Reconstruc-tion of
humeral length from measurements of its proximal and distal
fragments. Braz J Morphol Sci 2009;26:5561.
17 Devi R, Thakar MK, Nath S. Estimation of humeral length from its
fragmentary dimensions. Hum Biol Rev 2014;3:1524.
18 Gayatri, Kamdi A, Sherke AR, Krishnaiah M, Sharada HR.
Estimation of humerus length from its segments in Telangana state. J
Dent Med Sci 2014;13:1821.
19 Premchand SA, Manjappa T. Reconstruction of humeral length from
measurements of its segments in South Indian population. Int J Sci
Res 2014;3:19569.
20 Holman DJ, Bennett KA. Determination of sex from arm bone
measurements. Am J Phys Anthropol 1991;84:4216.
21 Riepert T, Drechsler T, Schild H, Nafe B, Mattern R. Estimation of
sex in the basis of radiographs of the calcaneus. Forensic Sci Int
1996;77:13340.
22 Bidmos MA, Dayal MR. Further evidence to show population
specificity of discriminant function equations for sex determina-tion
using the talus of South African blacks. J Forensic Sci 2004;49:1165
70.
23 Singh S, Singh SP. Identification of sex from the humerus. Indian J
Med Res 1972;60:10616.
24 Patil G, Kolagi S, Ramadurg U. Sexual dimorphism in the humerus:
South Indians. J Clin Diagn Res 2011;5:53841.
25 Iscan MY, Loth SR, King CA, Shihai D, Yoshino M. Sexual
dimorphism in the humerus: a comparative analysis of Chinese,
Japanese and Thais. Forensic Sci Int 1998;98:1729.
26 Soni G, Dhall U, Chhabra S. Determination of sex from humerus:
discriminant analysis. Aust J Forensic Sci 2013;45:14752.
27 Kranioti EF, Michalodimitrakis M. Sexual dimorphism of the
humerus in contemporary Cretans a population-specific study
and a review of the literature. J Forensic Sci 2009;54:9961000.
2.
4. Basic Z, Anteric I, Vilovic K, Petaros A, Bosnar A, Madzar T, et al.
Sex determination in skeletal remains from the medieval
 Sex identification and reconstruction of length of humerus 55

Eastern Adriatic coast discriminant function analysis of humeri. Croat
Med J 2013;54:2728.
57. Gray JP, Wolfe LD. Height and sexual dimorphism of stature among
human societies. Am J Phys Anthropol 1980;53:44156.
4. Trinkaus E, Churchill SE, Ruff CB. Postcranial robusticity in Homo.
II: humeral bilateral asymmetry and bone plasticity. Am J Phys
Anthropol 1994;93:134.
5. Ruff CB, Walker A, Trinkaus E. Postcranial robusticity in Homo. III:
ontogeny. Am J Phys Anthropol 1994;93:3554.

23
Terjemahan
Seks identifikasi dan rekonstruksi panjang
humerus dari fragmen tulang
Tujuan dari penelitian ini adalah untuk
menghitung total panjang humerus dan
mengidentifikasi jenis kelamin dari fragmen di
mesir. Dengan mempelajari 150 humerus kanan
dewasa (75 pria dan 75 wanita). Hunerus dibagi
menjadi 7 fragmen menurut anatomi. Data yang
diperoleh menjadi sasaran analisis statistik
deskriptif. Porsi fragmentaris terpanjang
menunjukkan hasil yang baik dengan paling
dekat dengan total panjang humerus. Semua
fragmen menunjukkan perbedaan seksual yang
signifikan (P <0,001) antara pria dan wanita
kecuali H2. Panjang total humerus menunjukkan
presentase akurasi tertinggi (93,3%) dikuti H4
(86,7%) dan H7 (83,3%) untuk identifikasi jenis
kelamin. Akhirnya, melihat dari hasil pengukuran
humerus yang berbeda di penduduk mesir maka
panjang humerus dapat diperkirakan dan jenis
kelamin dapat diidentifikasi.
1. Pendahuluan
Beberapa faktor penting bagi ahli forensic
mampu mengidentifikasi mayat tak
dikenal dalam banyak kasus antropologi
dan peristiwa traumatis. Mengidentifikasi
jenis kelamin dari tubuh dan
memperkirakan perawakan tubuh yang
dianggap paling penting faktor-faktor
dalam membangun identitas mayat-mayat
yang terbatas, bagian-bagian tubuh, atau
bahkan kerangka fragments.
Pemeriksaan forensik, penentuan jenis
kelamin dianggap tugas sederhana karena
genitalia internal dan eksternal dapat
langsung menyatakan jenis kelamin. Di
sisi lain tangan, dalam kasus pembusukan
parah, bercampur aduk, dan mayat yang
dipotong-potong, menentukan jenis
kelamin almarhum adalah tugas yang
menantang. Selain itu, penentuan seks
penting untuk mengevaluasi parameter
lain profil biologis, seperti sebagai bentuk
tubuh dan usia.
Ada banyak teknik untuk menentukan
demografi (misalnya, seks dan ras) dari
sisa-sisa potongan tubuh dalam bidang
24
forensik Antropologi. Pemeriksaan
morfologi kualitatif (bebas-berirama
metode) adalah metode termudah dan
tercepat dengan akurasi 95-100% jika
kerangka keseluruhan tersedia dan
pengamat adalah seorang ahli. Metode ini
bergantung pada inspeksi visual
karakteristik fisik dan seksual dari tulang,
khas untuk unsur-unsur skeleton manusia.
Teknik yang kedua, metode
morphometric, bergantung pada
pengukuran dan teknik statistik. Metode
ini dianggap lebih menguntungkan untuk
evaluasi data dan aplikasi untuk skeleton.
Namun, banyak indeks bergantung pada
langsung jarak antara dua batas tulang,
dan rumit pola kurva osea tidak dapat
dipelajari.
Kemudian, kombinasi dari morphometric
dan meristic karakteristik digunakan
sebagai teknik baru. Geometris
morphometrics adalah metode yang dapat
menghitung perbedaan bentuk Koordinat
tulang di dimensional dua atau tiga (2D
atau 3D) sistem dengan mendapatkan
mean. Terbaru kemajuan geometris
morphometrics memungkinkan analisis
tulang konfigurasi dan determinasi seks.
Sulit untuk memperkirakan bentuk tubuh
dari potongan tubuh yang tersedia yaitu
fragmen tulang yang mengikuti massa
bencana atau bahkan dari arkeologi tetap.
Beberapa ahli forensik mengabaikan
fragmen tulang, berpikir bahwa ada
manfaat yang bisa diperoleh dari fragmen
tersebut; Namun, pada tahun 1935, Mu
ller merekam secara ilmiah untuk
memperkirakan panjang dari fragment
tulang.
Telah dilaporkan bahwa perawakan
individu dapat diperkirakan dari panjang
tulang panjang limbs. Tulang paha
dianggap tulang yang paling ideal untuk
memperkirakan bentuk tubuh di sebagian
besar studi masa lalu. Namun, populasi
berbeda hubungan antara gerak-gerik dan
panjang ekstremitas tulang. Oleh karena
itu, persamaan khusus untuk estimasi
 bentuk tubuh diperlukan untuk setiap
populasi.
Banyak peneliti mempelajari dimorfisme
skeleton seksual dewasa menggunakan
dimensi tengkorak, wajah, panjang
tulang, tangan, kaki, dan tulang pelvis.
Para sarjana mengatakan bahwa studi
tertentu yang diperlukan untuk setiap
penduduk untuk mendapatkan hasil
akurat identifikasi seksual skeleton.
Diskriminan fungsi analisis telah
digunakan untuk memperkirakan jenis
kelamin dari tulang jika mereka diduga
menjadi seksual dimorphic. Panggul
dianggap tulang yang paling akurat untuk
seks, karena memungkinkan untuk
persalinan pada wanita. Kesimpulannya
adalah salah satu tulang panjang penting
karena kekuatannya, bahkan dalam
keadaan terfragmentasi, dan
dimungkinkan untuk dipulihkan dalam
kasus forensik. Teknik klasik osteometric
telah digunakan untuk menyadari nilai
memperkirakan tulang lengan atas
panjang dari para fragments dan
mengkonfirmasi keberadaan dimorfisme
seksual dalam humerus. Dalam
anthropometric studi, menyebutkan
bahwa cukup belajar tulang. Ini
memainkan peran penting dalam
identifikasi seks, estimasi perawakan
individu, forensik.
Tujuan dari penelitian ini adalah untuk
memperoleh persamaan regresi untuk
membangun panjang total tulang lengan
atas dan diskriminan persamaan fungsi
seksual identifikasi tulang menggunakan
berbeda pada lengan atas fragmentaris
pengukuran dalam populasi Mesir.
2. Bahan dan Metode
Koleksi tulang humeri yang digunakan
dalam penelitian ini diperoleh dari mayat
bedah dari mesir. Tulang-tulang ini
dipilih dalam keadaan kering dan
sepenuhnya diketahui negara. Tulang
yang cacat, mengecil, atau patologis tidak
termasuk dalam studi ini. Usia dan jenis
kelamin mayat tercatat; Namun,
25
informasi penuh tentang individu ini tidak
tersedia. Dengan teknik sederhana
sampling acak, 150 humeri (75 Laki-laki,
perempuan 75) dari populasi Mesir yang
dipilih. Usia untuk kedua jenis kelamin
pada kematian berkisar antara 20 dan 60
tahun. Periode sejarah manusia yang
tulang telah dikumpulkan tidak dicatat
dalam arsip dari anatomi Departemen
Minia dan Universitas Kairo. Tulang
humeri hanya digunakan dalam penelitian
ini karena kedua humeri dari individu
yang sama tersedia dan sisi kanan sisi
yang dominan. Delapan pengukuran
diambil dari masing-masing tulang lengan
atas. Masing-masing tulang lengan atas
adalah terfragmentasi dengan
menggambar garis imajiner di berbeda
3. Analisis statistik
Data yang diperoleh dianalisis
menggunakan paket statistik, SPSS, versi
20,0. Maksud dan standar deviasi
dihitung untuk semua pengukuran.
3.1. Panjang Tulang lengan atas.
Regresi formula adalah metode yang
paling diterima dalam menentukan
tubuh yang bertubuh dari berbagai
dimensi anthropometric. 38 dalam
studi ini, analisis regresi linear
sederhana sudah dilakukan untuk
memperoleh persamaan regresi untuk
memperkirakan total tulang lengan
atas dari fragmen yang panjang.
Parameter yang signifikan, t-rasio, P-
nilai dan korelasi koefisien, diberikan
sambil menghitung panjang humerus
dihubungkan dengan fragmen tulang
lengan atas total panjang.
3.2. Estimasi Jenis Kelamin
Siswa t-tes dilakukan untuk
membangun yang perbedaan
signifikan antara pria dan wanita
pada hasil pengukuran. Univariat
diskriminan fungsi analisis ini
dilakukan untuk signifikansi
pengukuran untuk menguji efisiensi
dalam estimasi seks. Koefisien dan
konstanta yang diperoleh untuk
menghitung diskriminan fungsi nilai
 dan persamaan. Selain itu, menandai
beberapa poin, yang rata-rata laki-
laki dan perempuan diperoleh. Semua
statistik perhitungan dan
perbandingan telah dilakukan di 5%
tingkat makna (yaitu, P = 0.05).
4. Hasil
Studi ini meneliti 150 tulang humerus (75
laki-laki dan 75 Laki-laki). Delapan
pengukuran diambil dari masing-masing
tulang lengan atas. Terlepas dari jenis
kelamin, panjang total tulang lengan atas
adalah 31.37 1.33 cm; korelasi
koefisien untuk semua pengukuran tulang
lengan atas versus total panjang (H1)
yang signifikan (P < 0,05) (Tabel 1).
Nilai-nilai mean untuk laki-laki dan
perempuan dan proporsi pengukuran
panjang total humeri disajikan dalam
Tabel 2. Fragmen terpanjang (H4)
mengungkapkan kedekatan terdekat
panjang total hasil di kedua jenis kelamin
(laki-laki71.89 1.29% [23.31 0,72 cm]
dan perempuan 72.51 1.44% [21.98
0,63 cm]) (Tabel 2).
Tabel 3 menyediakan korelasi koefisien
(r), t-rasio, Pvalue, dan persamaan regresi
untuk semua pengukuran laki-laki dan
perempuan. Ikhtisar fragmen
menunjukkan signifikan positif korelasi
dengan total panjang humeri (P < 0,05);
Namun, H3 dan H8 fragmen dalam
wanita dan H2, H5, dan fragmen H8 pada
laki-laki yang tidak signifikan (P > 0,05).
Oleh siswa t-tes, Semua pengukuran
fragmen tulang lengan atas
mengungkapkan perbedaan yang
signifikan antara nilai-nilai rata-rata Laki-
laki dan perempuan (P < 0.001) (kecuali
fragmen H2 mana ada perbedaan yang
signifikan, P > 0,05), yang menunjukkan
adanya dimorfisme seksual dalam
pengukuran tulang lengan atas fragmen
bagi penduduk Mesir (Tabel 4). Statistik
diskriminan fungsi yang diperkirakan
jenis kelamin tulang lengan atas tidak
diketahui fragmen disajikan dalam tabel
5. Jenis kelamin diperkirakan dari
fragmen tulang lengan atas dengan
26
menghitung diskriminan Skor
([pengukuran koefisien] + konstan). The -
sectioning untuk semua fungsi adalah nol;
Jika Skor adalah P0, dianggap sebagai
laki-laki; Namun, jika Skor < 0, itu
dianggap Laki-laki. Pengukuran yang
paling efektif untuk seks estimasi oleh
univariat Analisis diskriminan sudah H1
fragmen (total panjang humerus), yang
memiliki persentase tertinggi akurasi
(93,3%). Hal ini diikuti oleh fragmen H4
(akurasi 86.7%), fragmen H7 (vertikal
diameter kepala, 83.3%), H8 fragmen
(biepicondylar lebar, 76.7%), fragmen H5
(73.3%), fragmen H6 (70%) dan H3
fragmen (63.3%) (Tabel 5).
Tabel 5 juga menyajikan poin demarking,
yang jumlah nilai berarti untuk pria dan
wanita yang dibagi oleh 2. Jika diukur
nilai lebih besar dari titik demarking, Ia
ditugaskan sebagai seorang laki-laki,
sementara nilai-nilai yang lebih rendah
yang disarankan Laki-laki.
5. Diskusi
Pengukuran panjang tulang panjang
sangat penting alat untuk memperkirakan
bentuk tubuh individu. Estimasi ini
memainkan peran penting untuk
penyelidikan medico-legal dalam
mengidentifikasi orang hilang. Karena
hasilnya adalah terpanjang, terbesar dan
terkuat (bahkan dalam keadaan
terfragmentasi) tulang dari tubuh bagian
atas, postur tubuh estimasi dapat
dilakukan dari tulang lengan atas dalam
ketiadaan panjang lain tepat tulang,
seperti tulang paha. Oleh karena itu,
sangatlah penting untuk mengidentifikasi
panjang humerus dari measurements.
Yang fragmental penting dari tulang
lengan atas total panjang dalam
mengidentifikasi fitur tertentu dari
populasi telah dilaporkan. Analisis regresi
lebih cocok untuk memperkirakan
hubungan antara variabel: antara
ketinggian individu dan panjang tulang
panjang dan antara panjang maksimum
tulang panjang dan pengukuran
 fragments. Mereka telah diusulkan bahwa
setiap penduduk memiliki spesifik regresi
persamaan yang tidak harus diterapkan
populasi lain, seperti ini dapat
mengakibatkan pengabaian atau terlalu
tinggi stature. Mysorekar et
al.melaporkan perbedaan yang signifikan
dalam tulang lengan atas panjang antara
kanan dan kiri sisi dan dihitung
persamaan yang berbeda untuk setiap sisi.
Di masa sekarang belajar, kami
memformulasikan persamaan regresi
untuk setiap fragmen humerus, dengan
seks diidentifikasi di sisi kanan pada
populasi Mesir. Ini adalah untuk
memperkirakan panjang humerus untuk
mendapatkan hasil yang akurat.
6. Kesimpulan
Penelitian kami telah menunjukkan
bahwa hasil berguna pada tulang, bahkan
dalam sebuah negara yang terfragmentasi,
untuk mengidentifikasi seks dan
memperkirakan panjang humerus.
Mengidentifikasi mayat yang bercampur
dan mayat yang dipotong-potong , seperti
dalam kasus dari ledakan, bencana udara,
bencana alam, mutilasi, atau dalam kasus
tertentu pembunuhan, dapat membantu
untuk memperkirakan tubuh dan
membedakan jenis kelamin individu
dengan persentase tertinggi akurasi
menggunakan total panjang dari humerus
(93,3%). Oleh karena itu, penelitian kami
membantu untuk forensik dan
anthropometric dalam mengidentifikasi
sisa-sisa orang mati tidak diketahui
bentuk badannya di Mesir. Karena tidak
adanya tubuh orang yang termasuk dalam
studi ini, itu sulit untuk menguji makna
dari hasil dengan fragmen-fragmen
tulang. Oleh karena itu, lebih lanjut studi
diperlukan ketika informasi lebih lanjut
tentang individu yang tersedia, dan tulang
lengan atas kedua tulang, kanan dan kiri
diminta.

27