Ninety-nine children with surgically treated limb fractures were randomized to receive immersive virtual reality therapy (n=33), non-immersive virtual reality therapy (n=33), or standard care (n=33). The primary outcome was perioperative pain, assessed using FPS-R and FLACC scores. Secondary outcomes included perioperative fear, anxiety (measured by CMFS and m-YPAS), and serum TNF-α and cortisol concentrations. Outcomes were measured before surgery and up to 24 hours after surgery. Overall, the results of the study revealed that both VR interventions significantly reduced postoperative pain, fear, and anxiety compared to control, with immersive VR showing a greater effect. Immersive VR therapy appears to be an effective non-pharmacological adjunct for managing postoperative discomfort in pediatric fracture patients.