1. Get VirtualBox version 5.X.XX. (NOT 6.X.XX) This is important because 3D acceleration got discontinued without which the game will not run.

2. Install Windows XP virtual machine and set it up. Here is a guide: https://www.makeuseof.com/tag/download-windows-xp-for-free-and-legally-straight-from-microsoft-si/

3. Once set up start the VM again and press F8 immediately and select "Safe Mode with Networking".

4. Once booted press "Devices" > "Insert Guest Additions CD Image...".

5. Install and make sure to check Direct 3D support.

6. Install the game etc it should work now.

7. Fix in-game resolution using this guide: https://www.wsgf.org/dr/pirates-caribbean-worlds-end/en I used HxD to edit the executable.

Note: You probably don't need Windows XP specifically, but most people here are for nostalgia's sake, so it fits. There are many good tutorials out there on how to get VirtualBox set up, so I am not going to explain that here. I just wanted to share how I go the game to work on Windows 10 without it working on Windows 10.

Please comment any tips or better ways to do this as this is just a quick guide to help point people in the right direction to get the game working in the 2020's.