Timing of surgery for ankle fractures is largely dependent on the condition of the surrounding soft-tissues. This study aimed to determine the clinical effectiveness of a pre-operative in-cast artero-venous (AV) impulse device in the management of closed ankle fractures requiring surgery.A consecutive series of 64 closed ankle fractures were managed using the AV impulse system prior to surgery. Patients were compared to 73 consecutive closed ankle fractures managed surgically in the same unit immediately prior to the implementation of the AV impulse device study. Outcomes measured were time to surgery, length of hospital stay and surgical site infections.Median length of time to surgery, hospital stay duration and surgical site infections were all significantly reduced in the study group as compared to the control group.In-cast intermittent AV compression foot pumps in the pre-operative management of closed ankle fractures were associated with earlier surgery, earlier discharge and reduced complications.