Your Step 1 ensures that you will not be cutoff from any interviews as far as the board goes. Do not go into ortho because your score permits it, go into ortho because there are things in ortho that you find and love that are not found in other fields. Ortho is competitive, yes, but it is not ophtho, derm, or radiology; it is not an easy lifestyle and certainly not an easy residency.
If you love to work hard, ortho might be for you, but you will need good clinical grades to get there. Clinic is not hard to excel in, do well on the standardized exam and do the basics, arrive early, stay late, know EVERYTHING about your patients, their treatment, and keep your mouth shut as much as possible. Speak when spoken to, it's not too hard.
As far as research goes, only do a year off if you have a strong interest in research or you have an interest in academic medicine. 4th year is an easy time to get some research done.
Work hard, see if you love it, and then decide. But do not let your 251 make your decision, or you're going to end up being an unhappy ortho that wanted to be something else, be it a family practice doc or a dermatologist.
