Fatigue fracture of the pubic ramus following total hip arthroplasty with unusual delayed healing.

A 73-year-old woman with fatigue fracture of the right pubic rami following total hip arthroplasty had a long delay to union. Discrepancy in leg lengths due to nonunion of an intertrochanteric osteotomy of the contralateral hip may have contributed to the fatigue fracture of the pubic rami. The postarthroplasty fatigue fractures in patients reported in the literature were of the compression type and healed within a few weeks. In the patient reported here, the fracture was of the distraction type and was characterized by failure of callus formation with slow healing requiring two years to union.