With those stats and that many interviews, you should have matched. I'm guessing that you didn't perform well on your interviews if you don't have any red flags on your application.

GIven your stats, I would advise the research route. Then double apply next year to ortho and something else as backup. You have some research, but not a ton. A dedicated year will help you pad the research part of your CV, and probably more importantly, make some connections to academic orthopaedic surgeons who can help you next cycle. In my opinion, a year in general surgery is a waste. It is tiring and it doesn't add anything new or interesting to your application that is related to ortho.

Good luck with your decision.

Thank you for the advice! I keep getting mixed messages on research fellowship or prelim year so I am thankful for the insight.

As far as not matching, I am just as shocked as you. Although I wasn't necessarily sure I would get some of my top choices, I didn't think I would not match at all and had a great list of more reasonable options. I don't have any red flags on my application as far as I know and my letters of recommendation that I saw were glowing. The only thing I can assume is that my school is not very well known to place specialties with their focus being mostly on primary care. The 10 people in my class that didn't match were all very qualified surgical sub-specialty candidates. I don't have a lot of insight on how much a school name matters but I am worried about this going forward and looking to improve my record somehow.

I agree w/ butterfingerbbs. With those stats + that many interviews you should have matched easily. You obviously have a great application package that isn't the barrier to getting into ortho. I would guess your interview performance was the cause. A similar situation happened to an ortho resident I know at a top-10 program, he was just too passive during interviews to make an impression, he is a quiet, understated, hardworking dude by nature. He ended up doing a prelim gen surg year and worked his butt off on his ortho rotations as the intern - he obviously killed it and got all the letters he needed to reapply ortho successfully.

If you are deadset on ortho I don't think you need to worry about "buffing" your application anymore. I would find an opportunity, either prelim gen surg or an ortho research fellowship to work closely with an orthopaedic department and impress. So whatever opportunity give you the most time with ortho in a meaningful capacity, I would take. And apply to a backup speciality next year, just in case, but I think you have the application to be a successful reapplicant.

Very sorry to hear that you didn't match. I know the despair you must be feeling because I felt it myself when I didn't match last year. I chose the prelim surgery route and matched this year. With your stats and that many interviews I would think the only explanation is that you didn't interview well. Reapply next year and hire an interview coach to help you prep. Next year, do not believe program directors when they tell you to "just relax, you're choosing us just as much as we're choosing you". Sell yourself like crazy.

Honestly, it probably doesn't matter whether you choose to do research vs. a prelim year. With your stats you will get interviews again and next year you'll rock them. Personally, I chose prelim surgery because I was done f-ing around and wanted to finally do some doctoring rather than stare at a computer screen all day. But sortof ended up doing that anyway.

Haven't looked at this website in years. However, it's that time of year (I think it still works that way) when people like the above find out they didn't match. Actually I guess that was last month. Anyway, I've been there. I didn't match into ortho my first go around, and it was a complete shock. I had similar to the original poster, but apparently I'm not as smart because my board scores were not as high. The program directors where I rotated and at my home institution could not or would not tell me what the issue was. They were all surprised too. "Fell through the cracks" was a phrase they liked to use. That's pretty meaningless to someone who didn't match and wants to fix whatever went wrong. I did the prelim year, primarily because I couldn't find a decent research spot that would pay enough to support a family. I had a wife and three kids by that time. The prelim year didn't help me much other than I think it gave me a little leg up at the program I rotated at. I went to all the ortho rounds and such even though I was gen surg. I ended up ranking them lower and matched higher on my second time around so I don't know how they ranked me. I didn't accomplish any research that year, and frankly it's tough to realistically get papers out and published and on your CV by the time applications are due again. However, I'm sure some institutions can do it. Just check into that aspect before you invest just one year, or think about maybe two. A friend in the same prelim program had not matched into ortho twice in a row and that next year failed to match a third time. However, a new program spot opened up one month after he started general surgery residency and he is now a practicing orthopaedist. That's rare, but it's hopeful.
I'm about to start my Thursday clinic as a hand surgeon in a minute. Today the fact that I didn't match the first time around doesn't affect me or my practice. Maybe it just makes me appreciate what I have a little more. That and I suppose I could do a sentinel lymph node biopsy myself when I resect a melanoma from a finger if I really needed to thanks to that year of gen surg.
Press forward, work hard. Success is well within your reach.