When subjected to extreme loads and ultra-low cycling conditions, the primary mode of failure in a ball screw is that excessive plastic contact deformation of the raceway surface exceeds acceptable limits. Consequently, traditional fatigue life theories based on pitting fatigue are not applicable in this context. This study evaluated the load distribution within the ball screw, considering factors such as the nut position and screw length. The plastic deformation of the raceway surfaces is analyzed using Thornton’s elastoplastic theory. Furthermore, this paper integrates the concepts of plastic deformation and fatigue elastic life to investigate the fatigue elastic life of ball screws under extreme conditions. To validate the proposed approach, the calculated results are compared with those from previous experimental studies, confirming its effectiveness. When the ratio of the nut position to the screw length approaches 0.7, the fatigue elastic life of the ball screw achieves its maximum. An increase in screw length, load, or raceway conformity ratio leads to a decrease in fatigue elastic life. Conversely, an increase in contact angle and ball diameter enhances the fatigue elastic life.