Periarticular injuries of the lower extremity are known for wound healing and infection complications. The role for incisional negative pressure wound therapy for lower extremity periarticular fractures has expanded over the last 10 years in hopes of minimizing complications. To date, there is no standardized published protocol of how negative pressure wound therapy is best used in lower extremity periarticular fractures. A review of strategies to decrease complications associated with the operative management of lower extremity periarticular fractures to include the use of incisional negative pressure wound therapy is presented.