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