Oblivion meets Soldier of Fortune.
The dialogue is well done and graphics capture the mood of a post-apocalyptic wasteland. There are also little homages to the first 2 Fallout games that will leave old school fans of the series feeling warm and fuzzy.
If you enjoy RPGs and character customization, then you should enjoy this one. Some of the dialogue options seem a bit limited and some of the combat becomes a bit formulaic (i.e. once you get a weapon that suits your playing style, you will find that you do not deviate very much from using that one weapon). I was also disappointed at how wimpy the "power fist" and the "super sledge" were in this game. I loved using those bad boys in the first two games. I used to chuckle with glee every time the super sledge connected and sent a mutie sliding across the ground.
This game has a mature rating for good reason. If you like a gruesome splatterfest, then this is the game for you. It even has a "perk" that you can obtain to allow you to ramp up the gore with every kill, much like the original 2.