Should i give up based on step 1

That is quite low for ortho. You should choose your aways VERY carefully and make sure you apply to a backup specialty like GS or something less competitive.

Would doing a research year before 4th year be beneficial for LOR/Papers? What other backups do people apply to? I really don't love GS.

Research years can be very beneficial if you are able to publish a bunch of stuff and get good LOR out of it. Additionally if you mesh well with the program that you do research at, they may be willing to overlook your scores. Also, I would look at rotating at community programs and use your away rotations to convince them that you work hard enough to overlook low scores. Then rock out step 2.

I just graduated residency with a guy that had lower step 1 score than you and know many others that have match with scores in 220's. It's not easy and it is super stressful but if ortho is what you really want to do, you can probably find a way in. If you don't get in, Cincinnati and May both have research years that are very productive and I think most of the people that do them get in afterwards. Good luck.

Thank you for your reply. Do you have advice on how many Away rotations would be ideal? and if I should do them all at community programs? I tried to make a list of schools that won't screen me out but not all schools list that information.

I would do as many as your program allowed. Most seem to let their students do 2-3 but have know some people that have done more. Most programs will probably not advertise their cutoffs. My advice would be to stick to the community programs as they may not be as quick to dismiss an applicant due to score alone. However, if you know someone at a program or really want to be at a specific program you should probably consider rotating there. Also I'd take step 2 early and (like I said before) rock it. If you score much better on step 2 and can put it on your applications, it could really help.

Would research still help for community programs? Where would I find a list of community vs university programs (FRIEDA?) I think I can def improve for step 2. Would it be wise to also apply to all ortho programs since I don't know which ones screen?

you should probably double apply unless you are fine with taking 1-2 research years or scrambling into a non-ortho field.

I was planning on taking a year of research between third and fourth year. Would you still recommend I double apply if I do that and am successful with networking and publications?

Lots of programs have cut offs...most (not all) will probably filter out your app before ever seeing 50+ pubs based on Step I alone. Most programs are gonna look at 1) Step 1 2) AOA? 3) Clerkship Grades 4) Step 2 > Pubs > everything else

I'd honestly think about what you like most about ortho and double apply. You can check many similar boxes in different fields

Ya, I'm not sure what other field I would apply to. I want to do surgery, but I don't really love general surgery. The other surgical fields seem just as competitive. So I'm not sure what else I would apply into, unless it wasn't a surgical field.

i know of a few ortho applicants who scrambled into anesthesia and radiology. they are less competitive, but still have procedures. if you like ortho-related stuff, anesthesia has regional fellowships and radiology has MSK and IR.