An autopsy has found that accused sex trafficker Jeffrey Epstein had multiple bone fractures in his neck, furthering questions about the circumstances of his reported suicide at the Metropolitan Correctional Center late last week.

Two sources familiar with Epstein’s medical examination, who spoke on the condition of anonymity, told the Washington Post that multiple breaks were found in Epstein’s neck bones. One of the fractured bones is the hyoid bone, a horseshoe-shaped bone in the front of the neck, just under the lower jaw.

As the Washington Post report notes, research conducted on suicides by hanging has found fractures in some cases of hanging suicides, but a hyoid bone fracture can also indicate death by homicidal strangulation. Experts told the newspaper that a hyoid bone fracture is more often a result of homicide than of suicide.

“If, hypothetically, the hyoid bone is broken, that would generally raise questions about strangulation, but it is not definitive and does not exclude suicidal hanging,” Jonathan L. Arden, president of the National Association of Medical Examiners, told the Washington Post.

Arden was not involved in Epstein’s autopsy.

According to the report, the cause of death determination from Epstein’s autopsy remains pending. As CrimeOnline previously reported, the office of the Chief Medical Examiner Dr. Barbara Sampson released a media statement earlier this week confirming that an autopsy had been completed but that the medical examiner was seeking more information from law enforcement before making a determination about Epstein’s cause of death.

“The ME’s determination is pending further information at this time. At the request of those representing the decedent, and with the awareness of the federal prosecutor, I allowed a private pathologist (Dr. Michael Baden) to observe the autopsy examination. This is routine practice,” the statement read.

Baden told CrimeOnline that he was “involved” with the autopsy but that a gag order prevented him from sharing any further details. Baden, formerly the chief medical examiner in New York City, has previously consulted on cases of high-profile or controversial deaths. He performed an independent autopsy of Eric Garner, who died in Staten Island in 2014 after an NYPD officer placed him in a chokehold. Baden’s autopsy findings were consistent with medical examiner’s conclusion that Garner died as a result of neck compression.

In 2016, Baden was enlisted to perform an independent autopsy of Shannan Gilbert, whose mysterious disappearance in 2010 helped lead to the discovery of a burial ground believed to be connected to the Long Island Serial Killer, who has yet to be identified or apprehended. Authorities in Suffolk County have said that Gilbert, who was found dead in a marsh a few miles where the murder victims’ remains were discovered, likely died of natural causes, a claim challenged by her family. The official autopsy was inconclusive, and Baden’s independent autopsy reportedly found damage to Gilbert’s hyoid bone, which Baden said in a statement was “consistent with strangulation,” but he too was unable to make a conclusive determination about the cause of Gilbert’s death.

In response to a question about Epstein’s reported neck injuries, Sampson told the Washington Post that multiple factors must be considered in the determination of his cause of death.

“In all forensic investigations, all information must be synthesized to determine the cause and manner of death,” Sampson reportedly said. “Everything must be consistent; no single finding can be evaluated in a vacuum.”

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