A 42-year-old man injures his ankle on a slope.  He lost his balance and fell.  He’s not sure if it inverted or was rotated externally or all both.  He denies and other injuries, but is unable to bear weight.

On exam he has a good pulse and skin is intact without echymosis and the compartments are soft.  His ankle is tender bilaterally with mild swelling.  The foot is not tender.

His x-ray is shown below.

What type of injury to you see?

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