An orthopedic fastener (10) has a head (50) and a shank (20). The shank (20) extends from the head (50) to a distal tip (11). The shank (20) has a leading end (1) adjacent the distal tip (11) and a trailing end (3) adjacent the head (50). An intermediate transition (2) is positioned between the leading (1) and trailing ends (3). The leading end (1) has first threads (40) with one or more self-tapping cutting grooves (41) extending adjacent the distal tip (11) and through a plurality of the first threads (40). The trailing end (3) has a second thread (60) extending toward the head (50) from the intermediate transition (2). The intermediate transition (2) has one or more second cutting grooves (61) extending from at least a first thread (40) in the intermediate transition (2) through at least one of said second threads (60) to initiate tapping of the second threads (60) into cortical bone. The first and second cutting grooves (41, 61) in combination with the threads (40, 60) form threads in the bone to hold the fastener (10).
