M3 interested in Orthopedics -- Advice appreciated

Congrats on switching interests from EM to Ortho.
You seem to be on track to match given your decent step 1 and global health involvement. For now I'd suggest going to Ortho grand rounds when you can to show your interest. Perhaps getting involved in some of the basic science wouldn't be a bad idea either as it would give you something to talk about on the interview trail even if it is nowhere near published.
The most critical component however will be your away rotations and excelling at them to impress programs and get great letters of rec.
Regarding research, it helps a lot but it is not necessary to match (I had none).

I would recommend not taking Step II early. Your Step 1 score will qualify you for any residency in the country.

Steps at our program are used in 2 ways. First to screen, and yours would be above any screen. Second, after all interviews are done and rank discussions begin, if applicants are equal on interview points (most important) then boards do come in to play, which is not that common. Given the very high scores we get, in that scenario you would be average or below.

I would certainly not rule out rotations because you think you aren't competitive enough. Rotate wherever you want to go, not where you think you are going to get in. Nothing beats impressing attendings and residents on a Sub-I (or interview), and given that you are very unlikely to be screened out anywhere based on your paper application it would be a waste to settle.

Did you mean OSU, i.e. Ohio State, or OU, as in University of Oklahoma?

Especially if you are going to be limited for family/personal reasons from a geographic standpoint, you should try and rotate at as many programs as you can and apply to all of them, no matter what your odds. That would mean the Mount Carmel Program in addition to OSU and in DC you could likely expand your application net to northern VA (Where you might end up living anyway even if you match toa DC program). Also, if you can swing applying to Baltimore programs (Union Hospital etc) that would also be to your advantage. Programs that you don't apply to are essentially already a "No" as far as the possibility of an interview goes. Having family/personal reasons to limit your geographic search for a residency can be a handicap for you, because the pool of potential programs is already being prematurely truncated. You can make up for this by doing elective rotations at as many places as possible in your potential pool so you will be a known quantity at those centers when it comes to invitations for interviews. There are pluses and minuses to all programs but in terms of training, I think that most in your geographic areas provide exceptional resident education.

n light of your application, I wouldn't say that the publications would be a "big boost" per se, but definitely good to have. In this case, it is unlikely that either of the papers would be in print by the time you go to interview (or possibly even by the time you match depending on where you submit the publications) but you can still add to the research section of your application as "works in progress or submitted for publication or under pee review depending on that status"

That being said, relative to my response above and in light of your situation, strongly consider doing "second look visits" if you can swing it at the places you would like to match at most once you complete your first round of interviews.