Extra-articular fractures are fractures that occur outside of the joint.  These fractures can occur from blunt trauma or forcible blow to the end of the toes.  Nail damage can occur, ranging from a subungal hematoma to complete nail loss and injury to the nail bed.  The growth plate of the distal phalanx can be injured and possibly lead to partial or complete physeal arrest.  Fractures of the lesser toes proximal to the distal phalanx usually heal well and do not require any additional care other than taping and strapping.  If displaced, closed or open reduction with or without fixation is performed depending on the severity.

Pre and Postop ORIF Displaced Big Toe Intra-articular Pediatric Fracture

Pediatric Coalition Fracture of the DIPJ fifth toe initial and healed

Below is an x-ray image of an extra-articular fracture of the proximal phalanx of the hallux (great toe) of a child. the fracture line does not enter the joint.

Below is an x-ray of a severely comminuted fracture of the distal phalanx of an adult foot. Although this is a bad injury none of the fractures enter the interphalangeal joint.