Enrico Gasparotto lost the leader's pink jersey to team-mate Danilo Di Luca after being involved in a 30-man crash on stage four of the Giro d'Italia.
Di Luca's stage win was his fourth success of the season
Liquigas rider Di Luca, 31, won in a time of four hours 22:42 secs, beating Riccardo Ricco and race favourite Damiano Cunego in a sprint finish.
Di Luca, who has won five Giro stages in his career, leads Italian team-mate Franco Pellizotti by 26 seconds.
Cunego and world champion Paolo Bettini were also caught up in the pile-up.
The crash split the peloton in two and Cunego needed to change his bike in order to continue.
Ian McLeod of the Francaise des Jeux team was forced out of the race after suffering a broken collarbone in the accident.
The 26-year-old South African also suffered a fall in Sunday's second stage.
It was as if there was soap on the ground
Di Luca was keen to thank his team-mates for helping him achieve victory on the 153km leg, which concluded with a 17km climb, including 21 hairpin turns.
"I only worked for the last 200 metres, they worked hard for the entire climb," he said.
Gasparotto's challenge never recovered after his fall on a damp road, allowing the leading three riders to break well clear of the field.
"It was as if there was soap on the ground," said Bettini, another victim of the fall.
The tumble allowed the leading three to increase their advantage on the main pack to nearly seven minutes.
They were pegged back for a sprint finish, but Di Luca came out on top.
Thursday's fifth stage is a 173km route from Teano to Frascati, just outside Rome.