According to local police, Massimo Cacciatori, the Ancona trainer, and John Lloyd, the British referee, had to wade into the melee to pull people apart after a bad-tempered match had ended in a 2-1 victory for the English First Division side.
Cacciatori broke a bone in his face, apparently after being butted, and Lloyd fractured his right hand.
"Mr Lloyd told us he slipped and fell as he was trying to break up the fight and that's how he got hurt," a Carabinieri paramilitary police spokesman said. "I can't say who started it, but I can say it was very heated." He said magistrates would open an investigation.
The fight followed an ill-tempered encounter on the pitch. Two players from each side were booked in a match marred by scuffles and insults. Two Ancona players were carried off in the first half.
According to one report, a Birmingham director, David Gold, had water and other objects thrown at him at the final whistle and home fans tried to attack the referee.
During the match, the Birmingham physiotherapist, Neil McDiarmid, was said to have been pushed by Ancona's Davide Pentoni as he tried to treat Paul Tait for a head injury. Pentoni's own goal after 33 minutes had put Birmingham into a 2-0 lead. In another incident Cacciatori was reported to have grabbed the Birmingham forward Ricky Otto by the throat.
Police said insults also flew between rival fans, but they were far better behaved than the players.
The Birmingham fans were facing a night in Ancona after their charter plane developed a fault and was unable to leave for home on time.
nGary Penrice, the Queen's Park Rangers striker, has moved down a division to join Watford. The two clubs agreed a fee of pounds 300,000.Reuse content