The first question I would like to put out there is:
Do I have a chance getting into an orthopaedic residency?
I personally think this is a very important question. It is a reality check. And this is something that you have to look at without kid gloves. You can ask you parents and friends (unless they are in the field and honest), because that's like asking you mother if she thinks you are pretty/hansom. You need to be brutally honest with yourself and get someone else to review you application who will be honest as well.
Lets look at what "relatively" objective measures you have in your application that will help you get into the door.
This is definitely an area that gets a lot of press. Do programs have cutoffs and what are they? etc. Realize this is the only objective measurement that everyone has in common. So, most programs (I can not speak for all) use it in some way, shape or form, to get the numbers of applications down to a reasonable number to review for interview. Every program is different in this initial process. Some do have absolute cutoffs, some relative cutoffs, and others no cutoffs. It depends on the number of applications to the program. If you have 500 applicants, probably more like absolute cutoffs; if only 150, may be relative cutoffs. Regardless, the test will be used in someway, and you will need to do well on it.
This is were honesty and reality comes into play. If you score low (say 200-215 ave is now around 215), please be realistic. You are probably not going to one of the top 10 programs unless are able to pull some strings.
This is something that differs from university to university. Some schools are very liberal with the honors, and others not. Regardless, 2 rotations you need concentrate on getting honors in are surgery and orthopaedics. Now, we can be lenient on the surgery honors, but if you don't honor orthopaedics, you are definitely a tougher sell.
This may be considered by some, but the elections for AOA are not always complete when the applications come out. So it is difficult to use as an evaluation tool for every applicant. It does in general correlate with the number of honors at most institutions.
This is kind of hit or miss for me personally. Some applicants decide late, so should they take a year off and do research; find a project to tag on; do a month rotation. I think if you do research, you genuinely need to look as if you want to do research. Get a publication out of it, etc. I have review may applications were the research was kind of half ass, done so they can check that box off on the application. If you decide late to go into ortho, I feel it is better to concentrate on you strengths and make contacts who will be an advocate for you. If that means you end up doing research, fine. Make it look real though.
These need to be strong recommendations with key words. Words or statements like:
1. will be ranked high at our institution
2. we are actively recruiting for our program
3. one of the top students we have had this year; (or even better) on of the top students we have ever had.
Things that you don't want with you letter of recommendation.
1. you would not sign the waive to not be able to review you recommendation
2. a statement like " we tried to persuade him to go in to another less competitive area."
At most institutions, this does not get read until interview time. In general for most it is a none factor. Most of the statements say similar things like
1. the applicant or a family member had some interaction with an orthopaedic surgeon and that is what made them interested in it
2. the applicant was an athlete
3. the applicant likes to work with his/her hands
4. on a rotation, the application had an experience which shaped his/her decision.
so, for me, I read the statement and if I start to see this theme, no bonus points.
Now this personal statement can be a plus or a minus. It is tricky if you decide to go outside of the norm. If it is too artsy and you sound crazy, minus; if you are creative and interesting, plus. But this is tricky and I would only recommend this for the literary inclined.
In summary, most of these things are common sence. I don't think I am shedding a ton of light on the situation. The most important thing initially is to be realistic. If you don't have the numbers, you may need some other assistance, like an away rotation or people who can be advocates for you.
And is you are a good applicant (after being honest with yourself), you need to then ask yourself what makes you different. Something to set you apart, otherwise you all blend together.