yeah he's smiling because he's on laughing gas or morphine so he's off his tits and it is real it gone over the bone and through the muscle can you see that his leg is miss shaped where the stick is
his leg would be discoloured (black) due to blood clotting high up in the femoral artery, he'd also have a compound fracture of his shin bone without doubt. so yeah fake
umm i have smashed myself on many things and there is rarely and blood on the object. my brother smashed his head on a metal doorframe and that pissed out blood. even then there was only blood on the floor where he was laying. also, in the other photo you can see a more misshapen sectoin of the leg where the stck is going through. this looks pretty real to me. the whole skin of the leg is stretched over the stick too.