Proximal humeral fractures are common injuries, particularly among older patients. While postoperative wound infections are well-described, hematogenous infections in nonoperatively managed fractures are exceedingly rare. This case illustrates an early-onset posttraumatic osteomyelitis despite nonoperative fracture treatment, underlining the potential for hematogenous spread.

To highlight the diagnostic and therapeutic challenges of a hematogenous infection in a nonoperatively treated proximal humeral fracture.

An 85-year-old woman was admitted to the emergency department following recent-onset dizziness and a fall onto her left side, resulting in a severely displaced, extra-articular, bifocal three-part fracture of the proximal humerus. Due to the patient’s unstable condition and the suspicion of a systemic cause for the fall, the fracture was initially managed nonoperatively. Extensive cardiac and neurological evaluations showed no pathological findings, and the patient was discharged. Within 8 days, she was readmitted with signs of fulminant sepsis and died shortly thereafter. Transthoracic echocardiography during readmission revealed Staphylococcus aureus endocarditis, with septic emboli affecting the brain, multiple internal organs, and the previously fractured humeral head.

This case illustrates that hematogenous infections may develop even in conservatively managed fractures and can lead to rapid clinical deterioration. Clinicians should maintain a high index of suspicion for systemic infections in older patients with fractures, especially when unspecific symptoms such as dizziness precede the injury. Early recognition and interdisciplinary management are critical in preventing severe complications, including sepsis and osteomyelitis.