The invention comprises a medical implant system with implant having a fastener hole for a fastener and further including a fusion screw, positioned to avoid interference with the implant fastener. The medical implant system also includes a guide that is mounted in the fastener hole and from an edge of the implant which provides for defined adjustability for angulation, and optionally depth, to allow for placement of the fusion screw so as to avoid impingement with the implant and the fasteners that secure it in place. The invention also relates to a method of surgery using the system.