Thrust into open in his first Test in almost a decade and with Matt Renshaw moving to No.5, Maddinson's difficult innings ended when he chopped on from Marco Jansen.
The 34-year-old's return lasted 39 minutes, and his 33 balls made for the second-longest duck in Test history by an Australia and the longest by an opener.
Maddinson's surprise call up to the Test squad when Josh Inglis fractured his finger was an epic story last week, given the left-hander underwent chemotherapy and beat testicular cancer last year.
But it was also met with surprise, given Maddinson last played a first-class fixture in March 2025 and has not been around an Australian Test squad for some time.
It even sparked significant criticism from former Test opener Matthew Hayden, which prompted Travis Head to hit out at what he saw as a habit of negative comments from former players.
Australian selectors favoured Maddinson for his flexibility and ability to play spin, but ultimately did not receive the pay-off in the first innings.
Maddinson had been lucky to survive his 15th ball when South Africa opted not to review an lbw appeal from Wiaan Mulder that would have been upheld.
Head also fell in the first hour for nine, nicking a ball down leg after previously clipping two off his pads to the boundary.
Maddinson's selection came after he won the race to replace the injured Cameron Green, who could still return for the second Test.
The call to then open with him and move Renshaw down to No.5 left Head with his third opening partner in three Tests, after Jake Weatherald was axed after the Darwin loss to Bangladesh.
Australia have now used eight specialist opening pairings since David Warner retired in January 2024, not counting nightwatchmen or injury-enforced in-game changes.
Maddinson's call-up to the Test squad came as a shock. He played three Tests in late 2016, but hasn't appeared for Australia in red-ball cricket since.
He only overcame a battle with testicular cancer last year, and has not played a first-class match since March 2025.
Maddinson's call-up was initially met with criticism given his age, but Australia rate his ability to play spin.
Plenty of turn is expected on a Kingsmead pitch expected to become drier as the game goes on. South Africa are without spearhead quick Kagiso Rabada, who failed to overcome a hamstring injury.
The hosts picked two spinners, with Simon Harmer to partner Keshav Maharaj.
This series marks a clash between the world's top-two ranked sides, and Australia's first Tests in South Africa since the 2018 ball-tampering scandal.
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