Fracture-dislocation of the ankle
Fall off gutter.
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Ankle dislocation with complex, comminuted fractures of the medial and lateral malleoli, which are severely displaced. There are further fractures, most likely involving the posterior malleolus, that are not well visualised on plain x-ray along with apparent malalignment of the subtalar joint
Low-energy trauma, such as tripping over a kerb, can still result in severe injuries.