A tamping apparatus 10 is described that includes a cannula 12 that has a tubularwall 22 that includes a distal end portion 16 that defines a tamping face 17. Thecannula 12 also defines a longitudinally aligned aperture or lumen 23 that providesaccess for an insert 9,.a guide wire 11 and the injection of treatment materialssuch as a bone graft. The cannula 12 can have a straight or arcuate shape. The distalend portion 16 of the cannula 16 can also include a plurality of movable elements30 that can be a part of or connected to the tubular wall 22. The movable elements30 have tamping faces that can increase the total tamping surface of the tamp apparatus10. The tamp apparatus 10 can also include a cannula or stylet 26 that can be movedwithin aperture 23 of cannula 12. The stylet 26 has a distally directed tampingface 42 and is employed in aperture 23 to move elements 30 between the first positionand second position of tamp apparatus 10. The first position of tamp apparatus10 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 surfaceof the tamping apparatus 10. In another embodiment, the tamping apparatus 10includes a concentric cannula 12 and stylet that are connected together at theirrespective distal ends. In the first position the elements 30 are aligned withthe tubular wall 22 of the cannula 12. In the second position the tamping facesof the elements 30 are rotated and directed distally to increase the tamping surfaceof the tamping apparatus 10.
