Med School: Top 5 (in the ortho world, but not known otherwise)
Step 1: 219
Step 2: 205
Grades: Few honors in first year, none in years 2-3, honored all ortho rotations, HP everything else in 4th year
Applied: 145
Interviews: 7 (ranked them all, obviously)
Last year - applied: 130
Last year - interviews: 7 with all ranked

What I did with my time off: Research at a top notch institution with mentors that went to bat for me every step of the process. Remained a "US Senior". Did 2 aways (6 wks) during my research year, used free time during those rotations to assist in research which ended up getting accepted.

Ended up matching at an excellent program which also happens to be one of the places I did my aways this past year.

Med School: Univ. of South Alabama
Step 1: 237
Step 2: 225

Did not match last year although I did 3 away rotations and had 10 interviews. I ended up doing a prelim year in gen surgery at Univ. of South Alabama. I applied again and got 4 interviews for ortho.

Ended up I matched at WVU in Morgantown and which was the best program I interviewed at.

Best advice is to let the people making the rank lists know that you want to be there more than anyone else. Continue to stay in contact with the programs also.