A tamping apparatus 10 is described that includes a cannula 12 that has a tubular wall 22 that includes a distal end portion 16 that defines a tamping face 17. The cannula 12 also defines a longitudinally aligned aperture or lumen 23 that provides access for an insert 9,.a guide wire 11 and the injection of treatment materials such as a bone graft. The cannula 12 can have a straight or arcuate shape. The distal end portion 16 of the cannula 16 can also include a plurality of movable elements 30 that can be a part of or connected to the tubular wall 22. The movable elements 30 have tamping faces that can increase the total tamping surface of the tamp apparatus 10. The tamp apparatus 10 can also include a cannula or stylet 26 that can be moved within aperture 23 of cannula 12. The stylet 26 has a distally directed tamping face 42 and is employed in aperture 23 to move elements 30 between the first position and second position of tamp apparatus 10. The first position of tamp apparatus 10 is for approaching or withdrawing from the fracture. In the second position, the elements 30 rotate and the combination of the tamping faces of elements 30, cannula 12 tamping face 17 and stylet tamping face 42 increases the tamping surface of the tamping apparatus 10. In another embodiment, the tamping apparatus 10 includes a concentric cannula 12 and stylet that are connected together at their respective distal ends. In the first position the elements 30 are aligned with the tubular wall 22 of the cannula 12. In the second position the tamping faces of the elements 30 are rotated and directed distally to increase the tamping surface of the tamping apparatus 10.Linvention concerne un appareil de tassement 10 qui comprend une canule 12, qui a une paroi tubulaire 22 qui comprend une partie dextrémité distale 16 définissant une face de tassement 17. La canule 12 définit également une ouverture ou lumière 23 alignée longitudinalement qui fournit un accès pour un insert 9, un fil de guidag
