Fallout 3 is a great game... when it doesn't crash.
Fortunately, I never really had too many issues with it. If you are running Fallout 3 on a Win 7 OS, then you may have some more issues since Win 7 is not officially supported.
I basically had no issues with the game using Win XP except for the occasional crash. However, with Win 7 Fallout 3 crashes too often. As mentioned by Supernova1138 inserting the following lines did fix my issues a while ago.
bUseThreadedAI=0
iNumHWThreads=2
Note, that I only have the vanilla game installed with some mods on my laptop (with Win 7). I haven't installed any of the DLCs yet and I don't recall which patch I am currently using. The general rule is not to install a newer patch unless you are experiencing problems or if it adds more contents, or it is required to play one of the DLCs.