Fastening system for internal fixation

A system for positioning tension elements within a bone, the system comprising:

• a first elongated element configured to extend through a bone so that a distal end of the first elongated element extends outside the bone;
• a second elongated element including a tension element, the tension element having a proximal end and a distal end, the proximal end configured to mate with the distal end of the first elongated element;
• and
• an exchange tool comprising a barrel defining an elongated bore open between opposing ends and sized to receive and align at least a portion of the first and second elongated elements;
• and
• a distal anchor coupled to the distal end of the tension element, the distal anchor being incapable of passing through a bone opening,
• wherein the proximal end of the second elongated element defines a recess and the distal end of the first elongated element is configured to be received within the recess.