Virtual Reality-Assisted Cast Application in Children With Forearm Fractures

Inclusion Criteria: * Children aged 4 to 15 years. * Diagnosis of an isolated forearm fracture requiring cast application with traction (greenstick injuries plastic deformation if NOT over 20 degrees bayonet apposition ok if \<10 years and growth remains) * First cast application for the current fracture episode. * Typically developing children without a known developmental delay or cognitive impairment that would prevent participation in the study assessments. * Ability of the child to understand age-appropriate instructions and respond to pain, anxiety, and fear-related assessments with caregiver assistance when necessary. * At least one upper extremity free of immobilization, allowing heart rate assessment during the procedure. * Parent or legal guardian able to provide written informed consent. * Child assent when appropriate according to age and local ethics committee requirements. * Ability and willingness of the child and caregiver to attend an approximately 30-minute blinded child psychiatry assessment 1 day after cast application. Exclusion Criteria: * Open forearm fracture. * Multiple trauma or an additional painful injury that may affect pain, anxiety, or fear assessment. * Need for emergency surgery, procedural sedation, or general anesthesia during cast application. * Previous participation in this study. * Known developmental delay, cognitive impairment, autism spectrum disorder with inability to complete study assessments, or severe psychiatric disorder that may interfere with questionnaire-based evaluation. * Known epilepsy, photosensitive seizure disorder, severe motion sickness, vestibular disorder, or any condition considered unsafe for VR headset use. * Visual or hearing impairment preventing use of the VR intervention or completion of the assessments. * Head, face, or scalp injury preventing safe or comfortable use of a VR headset. * Nausea, dizziness, or severe discomfort before the procedure that would prevent VR use. * Refusal of the child or caregiver to participate. * Inability to complete the 1-day child psychiatry follow-up assessment.