While I was expecting an outright treason of the Fallout setting, more because of ineptitude than vice, I have the feeling the game is spot on. The ambiance, scenery and lighting of the Vault seem perfectly faithful to the series, with just the right dose of rust to enhance claustrophobia.
(...)
Now here's the point where things get messy. We're going to get onto the thorny problem of the combat. [...] We'll note that the developers repeated ad nauseam that the efficiency of your shots depend on your statistics and that the FPS skills of the player don't have any importance, and that all shots fired in real-time mode will be automatically aimed to the torso. [Here goes a lengthy description of the VATS system]
The idea seems to stand theoretically, but in facts I'm far from convinced. Firstly, during the presentation, either he was wearing a Power Armor and holding a Gatling gun and fighting hordes of super mutants armed with heavy machine guns, bakookas and supersledges or fighting ghouls with a 9mm and wearing just a leather armor, the demonstrator was just standing there, shooting long bursts without using any kind of tactics.
Besides, aimed shots, possible even with a minigun, looked far less effective to me than just "run right next to the baddy and empty my magazine in one burst".
(...)
Regarding monster design, I'm afraid they are completely off the mark. Forget about quirky, clumsy supermutants or weird ghouls with tree branches sticking out their skulls. All you'll get is overmuscular, overarmed orcs and undeads Oblivion style. But that was expected.