Patient presents with clinical findings consistent with a diagnosis of SMART Syndrome (Stromal interaction molecule 1 receptor-associated syndrome), a rare genetic disorder.  Symptoms noted include cutaneous syndactyly, involving the 3rd and 4th fingers, camptodactyly, and tufting of the distal phalanges.  Patient also exhibits craniofacial dysmorphism, notably midface hypoplasia and a broad nasal bridge.  Musculoskeletal abnormalities, including short stature and brachydactyly, are also present.  Genetic testing confirms a heterozygous pathogenic variant in the ESR1 gene, confirming the SMART Syndrome diagnosis.  Differential diagnosis included other syndromic brachydactylies, such as Apert syndrome and Pfeiffer syndrome.  These were ruled out based on genetic testing and the distinct constellation of clinical features.  Management will focus on symptomatic treatment and supportive care, addressing the specific needs of the patient related to their physical limitations.  Referral to specialists, including orthopedics, genetics, and craniofacial specialists, is indicated for comprehensive evaluation and long-term management.  Prognosis is variable and dependent on the severity of the individual patient's clinical manifestations.  Genetic counseling is recommended for the family to discuss the inheritance pattern and recurrence risk. Ongoing monitoring for potential complications, such as joint contractures and developmental delays, will be essential.