Jakeman, in this hack, you DO add the custom profile field through the admin cp.
What the file modification does it prevents a blank line from showing up on the thread page if a user has not put in a custom title. It's just a simple little routine that checks for a value in $post[fieldX], and if there is one, it assigns the value of $post[fieldX] to $extratitle, and $extratitle is formatted to include a line break. If there is no value in $post[fieldX], a blank string is assigned to $extratitle. When you put $extratitle in the postbit template, you do NOT put a linebreak between it and the next line (which is the standard title); that way, if it's blank, there will be no empty line, but if it's not blank, the variable includes a line break to keep the flow right.
In other words, it's done strictly for appearance.
As I said, originally, this was just a template modification that I pointed out at vbulletin.com. Someone asked me how to surpress the blank line that would show up for users with no custom title, and that's how it evolved into a file modification hack.