I hate to be the one to say it, because I am a pretty optomistic person, but you have several things going against you:

-IMG
-Boards

There are just too many good candidates vying for ortho spots. The only way you have hope is to kick some bootie on an away rotation and hope the stars and moon align.

Again, its a pretty competative field, and if you are not a super stellar person that everyone gets along with, are an unbelievably hard worker, and get a break, I dont think you'll get an ortho spot with your track history.

Thanks for the input. Obviously I realize I'm up against a lot here, and I'd like to get people's take on the prelim surgery approach (or even categorical with an attempt to switch). Any experience with these? Can the second even be done, or is it too big of a faux pas?
Thanks again

UMKC

I know several guys that took prelim surgery spots hoping to get an ortho spot that either dropped (a PGY-2 position) or reapply for a new PGY-1 slot the upcoming year.

The problem is that VERY VERY few slots open up, and their are already people in line for those slots (they are super easy to fill), i.e. hopeful prelims already at their program or people who interviewed/rotated in the past that didnt match.

Also, applying next year around there are just as many qualified candidates applying as last year, and unless something dramatic changes on your CV by the time you reapply then your chances are about the same for matching.

With your IMG status and board scores, you would have to apply to a ton of programs (very costly) just to land a small handful of interviews.

Being in a program myself, I can tell you you wouldnt even be looked at beyond those two items. Program directors want to be sure their residents will pass the boards so their residency program can continue to exist. Taking a chance on someone who has underperformed on standardized tests in the past is a leap of faith many will not make, especially with the pool of candidates that want to get into ortho.

Try to get a catergorical surgery spot (thats becoming even more competative right now, probably due to the 80 hour work week, more people are reconsidering surgery) if you think you could find a GS field you would like to go into. Also apply to prelims spots as backups....

In my opinion, seeing past ortho candidates and being involved in the interview process, without meeting you in person, I would have to say you wouldn't be considered at the majority of programs, but their are some IMG friendly programs, as well as some programs that dont emphasize scores as much (most programs DO look at the whole picture, but grades are up there).

I have been told that a 220-230 on step 1 is the cutoff for many programs, although AGAIN, I stress that the whole person is looked at if close to this range.

Good luck in your decisions, hope I wasnt too harsh, just dont think you have a chance. Go for it if you have the financial resources to apply to a ton of programs, and have some connections, great letters of recs, and can interview well!