just a little to add,
sounds like you are on the right track, thinking now of next year, ie.. aways and when to take step ii.
one thing that you will find is that there are always surprises. just as above, some places you feel are safety net programs you don't get an interview and others you think are a stretch you do. everything has to be discussed in general terms and you just have to integrate all the information you gather over the years from residents, attendings, program web pages, this site, your great grandmother, etc.. and try to make sense of it for you personally.
so here is some of my opinion. when trying to determine just a general idea of program competitiveness talk to attendings and residents who have already gone or are going through the process, type in the program in a search on this site and see how much it has been talked about or brought up. the usnews site, although not good for much, is a pretty generic list of SOME of the more competitive programs. it is kind of like supply and demand, the higher the number of applicants want to go somewhere the more competitive the program, which doesn't necessarily translate into better program, it is all based on what you personally want out of the experience. you need to sit down and determine your future goals (ie. program chair one day or the only orthopod in a rural community) and see which place will help you achieve them.
regionalism is real especially for applicants with good, but average for ortho scores. you should get interviews but most will PROBABLY be in the southeast. definitely do away rotation(s) and do well (that shouldn't need to be said) and this will help you spread to other areas or strengthen you application in the southeast. try to get letters from the aways, most importantly from their chair, program director, or both. they know what to write. although you may feel that the letter must be generic when only working with someone for a week or so, other programs you apply to are really only looking for a few key statements in these letters like, "very good orthopaedic applicant, we will consider ranking him/her at our own program, you should to", among other things. it looks good and is vital to have great letter(s) from your own program but it also says something when you can go other places and impress.
as for step ii. 228 on i is probably enough to get you interviews in the southeast and some in other areas, depending on connections such as programs your own attendings or letter writers trained at among other things. you will definately be more competitive with a high ii but there is also the danger of doing worse. although not as common some go down, even significantly and your probable 10 interviews could drop to 3-4. something to consider is taking step ii early but late enough that your scores will not be back until after you submit your application. that way if you are happy you can easily update and if you are not you have some ability to brush it under the carpet when invites are going out and during the interviews where it is not brought up.
anyway, all just my take on a few things. good luck to everyone in the match this year and in the future.
