How do you adjust it with no stem?
Radial/ulnal reduction or elongation surgery?
ouch!
I believe the spacers go outward and you have the option of a 65mm stem or an 85mm stem. Other than that I believe you can adjust the pads forward and back.
The armrests move forward/backward to adjust your cockpit length in the aerobars. It works fairly well as there is a good range in the pads. As far as the cowhorn of the cockpit, it can’t go forward or back. You are stuck with the one position if you are out of aero.
Overall, it takes some tinkering, but there is quite a bit of flexibility in the fit. I am enjoying mine so far.