Long-term functional and clinical outcome of combined targeted muscle reinnervation and osseointegration for functional bionic reconstruction in transhumeral amputees: a case series.

Only 3 male transhumeral amputees were included, so the results cannot be generalised to other amputee groups. There was no control group or comparison group, so the paper cannot show that the surgery caused the reported improvements. The patients received bone anchoring, nerve rerouting, rehabilitation, prosthetic training and fitting together, so the contribution of any single component cannot be separated. The patients differed in surgery timing, nerve transfers, rehabilitation protocol, prosthesis, and electrode method. Patient 1 had a very short humerus of about 6 cm and limited shoulder movement with the prosthesis. Patient 1's prosthesis wearing time decreased before assessment because he felt shoulder overuse. Patient 3 had 2 soft tissue corrections due to weight changes. Functional tests and embodiment were assessed only at follow-up for patients 2 and 3, so there is no before comparison for them. Patients who choose invasive procedures may differ from the general population.

The project received funding from the European Research Council under the European Union's Horizon 2020 grant agreement No 810346. No other conflicts of interest are reported in the supplied text.

Do not conclude that bone anchoring or nerve rerouting alone caused the improvement. The patients also received rehabilitation, prosthetic training and fitting, and only 3 cases were reported without a control group.