For Windows 10 just install high resolution patch, go to screen settings, pick 2x scalling. Obviously, graphics are outdated, but atmosphere, lore and quests in this game are superb. And comnat also. I enjoy random encounters where you can encounter two groups fighting, and then kill survivors and loot their bodies for guns, ammo and stimpaks. This is truly Fallout RPG game. Much better then modern Fallout 76 which is very shallow despite modern graphics.
This game is unplayable, I went on a road with cca 20 HP, witth no aid, and I constantly get ambushed and dying by groups of some kind of bandits. I died several times in a row. Group of 2-3 bandits attack me, every hit for a 3-6 HP, I die pretty fast. I think this game is poorly optimized and unbalanced for new players.
I played this game after almost 10 years and I can say this is a very good Fallout game. It's much better than Fallout 4 which is oversimplistic, console oriented game. The only thing that Fallout 4 has better than Fallout 3 is graphics. Everything else is much better in Fallout 3.