Placing orthopaedics at the centre of patient care

On 20 August, Professor Maritz Laubscher delivered his inaugural lecture under the title “Stronger together: research as a clinician is a team sport”.

“I’m first and foremost a clinician,” Professor Laubscher said. “I’ve always been – and that’s my first passion.”

A service, not a specialism

Laubscher spent much of his talk on Cape Town’s gunshot fracture caseload, a body of work born “more out of necessity” than from adherence to high-income-country protocol. Facing gunshot injury volumes far higher than the literature guiding international practice was designed to address, his division developed what has become known as the South African approach: prioritising resuscitation and circulation over the extensive surgical debridement recommended elsewhere, treating many gunshot fractures according to the same principles as closed fractures.

“This is quite out there,” he said, “and against a lot of the teaching in high-income settings.” It has also worked: outcomes data accumulated over years of publication has since given the approach an evidence base it did not start with. “In South Africa, we constantly have to do more with less,” he said. “And I quite enjoy that.”

The same instinct for turning constraint into method shaped other strands of his research. A chance laboratory result on a spine biopsy – a rapid tuberculosis (TB) test intended only for sputum samples, mistakenly run on tissue – became, in collaboration with Professor Michael Held, a study that transformed TB spine diagnosis. “We were amazed,” Laubscher recalled, “because we usually wait four to five weeks for TB cultures.” The finding has since reshaped diagnostic practice. A separate study on fracture healing in HIV-positive patients, undertaken with funding from the Wellcome Trust, overturned textbook assumptions about HIV as a risk factor for delayed bone union.

What began as individual projects has since grown into infrastructure. Laubscher and his collaborators established the Orthopaedic Research Collaborative in Africa (ORCA), built specifically to lift research output across low- and lower-middle-income countries on the continent. A national gunshot-fracture study drew in 37 orthopaedic units across all nine provinces, recording more than 3 500 cases and exposing how little of that burden reaches police statistics.

Most recently, a National Institute for Health and Care Research (NIHR) grant worth £4 million, with just under £1 million directed to the UCT unit, has funded a four-year Global Injury Group project with partners in the United Kingdom, Malawi, the United States of America, and Tanzania. The project is tracking the incidence of musculoskeletal injury across public hospitals in all four countries, working toward the continent’s first dedicated trauma research network. “Our overall aim is to have, in five years, an advanced research network across Africa; one with a higher research output, but also one that improves the care of patients with musculoskeletal injuries across South Africa.”

Made by more than research

Professor Lionel Green-Thompson, the dean of the Faculty of Health Sciences, began his closing remarks with an observation. “The real power of your presentation today is that you place orthopaedics at the service of our people,” he told Laubscher. “For me, that’s the greatest signal of the scholarship you’ve brought to your discipline.”

Professor Green-Thompson’s remarks located Laubscher’s scholarship in service of patients, and the scholar himself in service of others. “Professors are not made by research alone,” he said. He returned to the families in the room: the one Laubscher was born into, the clinical community that trained him, and the wider community of colleagues and collaborators who had built the evening’s occasion alongside him. Professorships, in his account, are collective achievements wearing an individual’s name.

“Professors are not made by research alone.”

He said that so much of Laubscher’s work exists only because people keep arriving in Cape Town’s trauma units with preventable injuries. “Sometimes we do the work that we do because our people are so sick,” Green-Thompson said. He asked the room to sit with that rather than move past it. The scale of injury from violence in the city, he suggested, is not incidental to the research record being celebrated, but the reason it exists at all.

Green-Thompson concluded by invoking Kenya’s first president, Jomo Kenyatta, paraphrasing a sentiment often attributed to him: that people can either spend their time recounting the achievements of past heroes, or get on with the work of building what comes next. An inaugural lecture, Green-Thompson suggested, sits at exactly that junction: a scholar’s story told in one breath, and a promise of continued work made in the next.