An orthopedic fastener has a head and a shank. The shank has a leading end portion adjacent a distal tip and a trailing end portion adjacent a head. An intermediate portion is positioned between the leading and trailing end portions. At the intermediate portion, the shank increases in diameter. The leading end portion has a first thread which includes one or more self-tapping cutting grooves extending adjacent the distal tip and through a plurality of the first threads. The intermediate portion has second threads extending toward the head from the leading end portion. The second threads of the intermediate portion are larger in outer diameter than the first threads in the leading end portion. The intermediate portion has one or more cutting grooves traversing at each of a leading transition at the leading end portion and at a trailing transition.
