Pain and anxiety management of children undergoing removal of bone pins is considered suboptimal and most children don’t benefit from any interventions for their pain and anxiety. The aim of this trial was to verify the efficacy of a virtual reality (VR) videogame (Exp) compared to a game on a tablet (Ctrl) for pain and anxiety management of children undergoing bone pins’ removal in orthopedic clinics. Pain was assessed using the 0-10 NRS and anxiety was measured using the 0-4 Child Fear Scale. We recruited 188 participants aged from 6 to 17 years. Mean age was 10.8 (3.3) years. Mean (SD) pain and anxiety during the procedure in the Exp and Ctrl group was 3.78 (3.14), 3.71 (2.80) for pain and for anxiety 1.24 (1.29), 1.31 (1.48), respectively. Adjusted mean difference between groups (ANCOVA) was 0.06, 97.5% CI (-0.93,1.04) for pain and -0.08 (-0.53, 0.37) for anxiety. Parents in the VR group showed higher level of satisfaction (p = 0.052). More results will be presented. Overall, there are no significant differences between the use of a game on VR, or on a tablet, for procedural pain and anxiety management of children undergoing a painful orthopedic procedure.