We report a case of bilateral and simultaneous triceps tendon rupture and scapular fracture (Orthopaedic Trauma Association [OTA] classification 14-A3.2) after a single generalized tonic-clonic seizure. To the best of our knowledge, the current literature reports only three cases of bilateral complete triceps tendon rupture in hemodialysis patients1-3 and one case of bilateral partial triceps tendon rupture in an athlete4. Scapular fractures are most commonly caused by high-energy trauma, electric shock, or convulsions5-7, and there are several published cases of bilateral scapular fracture secondary to seizure activity6,8,9. Our case emphasizes the importance of recognizing renal osteodystrophy and secondary hyperparathyroidism as common underlying conditions leading to orthopaedic injuries. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A forty-two-year-old left-hand-dominant man was admitted to the intensive care unit with profound hyponatremia after a witnessed, single, generalized tonic-clonic seizure following a missed dialysis appointment. The chief symptom was bilateral upper-extremity weakness and limited shoulder motion, which occurred immediately after the seizure. Past medical history was notable for hypertension, gout, and polycystic kidney disease with chronic renal failure that required hemodialysis. Medication included 2000 mg of calcium acetate three times per day for hyperphosphatemia. One week prior to the seizure, the patient had hypocalcemia (calcium, 6.0 mg/dL) and hyperphosphatemia (phosphate, 8.9 mg/dL), and two weeks prior to the seizure, the parathyroid hormone level was 1900 pg/mL. The laboratory values on admission are listed in Table I; hyponatremia, hypocalcemia, and hyperphosphatemia were all present. View this table: TABLE I Vital Signs and Laboratory Values on Admission Radiographs and computed tomography (CT) of both shoulders (Figs. 1 and 2), with axial and coronal reconstructions, demonstrated comminuted fractures of the scapulae inferior to the glenoid (OTA …